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General NPI Number Information
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NPI Number | 1245110014
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Entity Type | Individual
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Provider Name | LUIS ALEJANDRO GONZALEZ GONZALEZ
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Gender | Male
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Dates
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Enumeration Date | 09/03/2025
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Last Update Date | 11/25/2025
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Provider Practice Location Address
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Address Line | 3848 FAU BLVD STE 105
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City | BOCA RATON
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State | FL
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Zip | 33431-6437
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Country | US
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Telephone | 561-997-5210
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Fax |
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Provider Business Mailing Address
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Address Line | 40 W LAKE PASS
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City | NEWNAN
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State | GA
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Zip | 30263-4666
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Country | US
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Telephone |
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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 | 225100000X
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Taxonomy Name | Physical Therapist
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License Number | PTT43736
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License Number State | FL
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Taxonomy #2
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Taxonomy Code | 225100000X
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Taxonomy Name | Physical Therapist
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License Number | PT018118
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License Number State | GA
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