Provider Demographics
NPI:1427759661
Name:GONZALEZ, ANA LEYVIS (PTA)
Entity type:Individual
Prefix:
First Name:ANA
Middle Name:LEYVIS
Last Name:GONZALEZ
Suffix:
Gender:F
Credentials:PTA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:7720 CAMINO REAL APT E112
Mailing Address - Street 2:
Mailing Address - City:MIAMI
Mailing Address - State:FL
Mailing Address - Zip Code:33143-7156
Mailing Address - Country:US
Mailing Address - Phone:786-371-9972
Mailing Address - Fax:
Practice Address - Street 1:8000 W FLAGLER ST STE 103
Practice Address - Street 2:
Practice Address - City:MIAMI
Practice Address - State:FL
Practice Address - Zip Code:33144-2157
Practice Address - Country:US
Practice Address - Phone:305-456-9484
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2023-03-14
Last Update Date:2023-03-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FL30912225200000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225200000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapy Assistant