Provider Demographics
NPI:1194126508
Name:GONZALEZ-ACOSTA, KEISHLA MARIE (MSPT)
Entity type:Individual
Prefix:
First Name:KEISHLA
Middle Name:MARIE
Last Name:GONZALEZ-ACOSTA
Suffix:
Gender:F
Credentials:MSPT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 8580
Mailing Address - Street 2:
Mailing Address - City:CHRISTIANSTED
Mailing Address - State:VIRGIN ISLANDS
Mailing Address - Zip Code:00823
Mailing Address - Country:UM
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:5030 ANCHOR WAY
Practice Address - Street 2:SUITE 7
Practice Address - City:CHRISTIANSTES
Practice Address - State:VIRGIN ISLANDS
Practice Address - Zip Code:00823
Practice Address - Country:UM
Practice Address - Phone:340-719-7007
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2014-09-05
Last Update Date:2014-09-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VI1852251P0200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2251P0200XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical TherapistPediatrics