Provider Demographics
NPI:1871279190
Name:GONZALEZ, JESSICA ANA (PT, DPT)
Entity type:Individual
Prefix:
First Name:JESSICA
Middle Name:ANA
Last Name:GONZALEZ
Suffix:
Gender:F
Credentials:PT, DPT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:9288 NW 10TH ST
Mailing Address - Street 2:
Mailing Address - City:PLANTATION
Mailing Address - State:FL
Mailing Address - Zip Code:33322-4921
Mailing Address - Country:US
Mailing Address - Phone:954-651-2979
Mailing Address - Fax:
Practice Address - Street 1:9288 NW 10TH ST
Practice Address - Street 2:
Practice Address - City:PLANTATION
Practice Address - State:FL
Practice Address - Zip Code:33322-4921
Practice Address - Country:US
Practice Address - Phone:954-651-2979
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2023-06-22
Last Update Date:2023-06-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FL35249225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist