Provider Demographics
NPI:1306809140
Name:GONZALEZ ROMAN, LUISA E (LPT)
Entity type:Individual
Prefix:
First Name:LUISA
Middle Name:E
Last Name:GONZALEZ ROMAN
Suffix:
Gender:F
Credentials:LPT
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 8492
Mailing Address - Street 2:
Mailing Address - City:BAYAMON
Mailing Address - State:PR
Mailing Address - Zip Code:00960-8492
Mailing Address - Country:US
Mailing Address - Phone:787-784-0148
Mailing Address - Fax:787-784-0148
Practice Address - Street 1:URB LEVITTOWN
Practice Address - Street 2:P1449 AVE. BOULEVARD
Practice Address - City:TOA BAJA
Practice Address - State:PR
Practice Address - Zip Code:00949
Practice Address - Country:US
Practice Address - Phone:787-784-0148
Practice Address - Fax:787-784-0148
Is Sole Proprietor?:Not Answered
Enumeration Date:2006-04-11
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PR414225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist
Provider Identifiers
StateIdentifier IDID TypeIssuer
0084107Medicare ID - Type Unspecified