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General NPI Number Information
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NPI Number | 1194126508
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Entity Type | Individual
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Provider Name | KEISHLA MARIE GONZALEZ-ACOSTA MSPT
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Gender | Female
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Dates
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Enumeration Date | 09/05/2014
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Last Update Date | 04/27/2025
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Provider Practice Location Address
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Address Line | 825 TIFFANIE CT
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City | LEXINGTON
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State | KY
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Zip | 40514-4082
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Country | US
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Telephone | 787-459-6326
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Fax |
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Provider Business Mailing Address
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Address Line | 337 LUCILLE DR
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City | LEXINGTON
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State | KY
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Zip | 40511-8600
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Country | US
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Telephone | 787-459-6326
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Fax |
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 2251P0200X
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Taxonomy Name | Pediatric Physical Therapist
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License Number | 185
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License Number State | VI
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