=====================================================
General NPI Number Information
=====================================================
NPI Number | 1912777657
-----------------------------------------------------
Entity Type | Organization
-----------------------------------------------------
Legal Business Name | GONZALEZ REHAB PROFESSIONALS II LLC.
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 01/04/2024
-----------------------------------------------------
Last Update Date | 05/08/2025
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 4720 SE 15TH AVE STE 109
-----------------------------------------------------
City | CAPE CORAL
-----------------------------------------------------
State | FL
-----------------------------------------------------
Zip | 33904-9663
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 786-542-8777
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 4720 SE 15TH AVE STE 109
-----------------------------------------------------
City | CAPE CORAL
-----------------------------------------------------
State | FL
-----------------------------------------------------
Zip | 33904-9663
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 239-378-3070
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position | CORP MGER
-----------------------------------------------------
Name | GEISYS BLANCO OLIVERA
-----------------------------------------------------
Credential |
-----------------------------------------------------
Telephone | 239-378-3070
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 225100000X
-----------------------------------------------------
Taxonomy Name | Physical Therapist
-----------------------------------------------------
License Number |
-----------------------------------------------------
License Number State |
-----------------------------------------------------