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General NPI Number Information
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NPI Number | 1659986487
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Entity Type | Individual
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Provider Name | DAVID R GONZALEZ PTA, LMT
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Gender | Male
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Dates
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Enumeration Date | 09/09/2020
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Last Update Date | 09/23/2020
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Provider Practice Location Address
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Address Line | 1000 W PEMBROKE RD STE 316
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City | HALLANDALE BEACH
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State | FL
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Zip | 33009-2181
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Country | US
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Telephone | 305-308-4817
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Fax |
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Provider Business Mailing Address
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Address Line | 2810 N 34TH AVE
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City | HOLLYWOOD
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State | FL
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Zip | 33021-3139
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Country | US
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Telephone | 305-308-4817
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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 | 225200000X
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Taxonomy Name | Physical Therapy Assistant
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License Number | PTA22449
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License Number State | FL
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Taxonomy #2
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Taxonomy Code | 225700000X
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Taxonomy Name | Massage Therapist
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License Number | MA33593
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License Number State | FL
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