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NPI Code Detail

MEDICARE: MS. EVELYN GONZALEZ PTA

MEDICARE: MS. EVELYN GONZALEZ PTA
Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

# Taxonomy Code Taxonomy License Number License Number State
1225200000XPhysical Therapy Assistant8361FL

General Provider Information

NPI Number : 1972628428
Entity Type Code : Individual
Provider Name (Legal Business Name) : MS. EVELYN GONZALEZ PTA
Provider Business Mailing Address
First Line : 827 MCDONALD RD
Second Line :
City : PORT ORANGE
State : FL
Zip : 32129-3716
Country : US
Telephone Number : 386-212-5312
Fax Number :
Provider Business Practice Location Address
First Line : 350 S RIDGEWOOD AVE
Second Line :
City : ORMOND BEACH
State : FL
Zip : 32174-7028
Country : US
Telephone Number : 386-677-4545
Fax Number :
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 03/20/2007
Last Update Date : 07/08/2007

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