Provider Demographics
NPI:1962171017
Name:GONZALEZ ORTEGA, YAQUEXI CAROLINA (PHYSICAL THERAPIST)
Entity type:Individual
Prefix:
First Name:YAQUEXI
Middle Name:CAROLINA
Last Name:GONZALEZ ORTEGA
Suffix:
Gender:F
Credentials:PHYSICAL THERAPIST
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:390 COMMONWEALTH AVE APT 401
Mailing Address - Street 2:
Mailing Address - City:BOSTON
Mailing Address - State:MA
Mailing Address - Zip Code:02215-2824
Mailing Address - Country:US
Mailing Address - Phone:954-592-6043
Mailing Address - Fax:
Practice Address - Street 1:200 RESERVOIR ST
Practice Address - Street 2:
Practice Address - City:NEEDHAM HEIGHTS
Practice Address - State:MA
Practice Address - Zip Code:02494-3191
Practice Address - Country:US
Practice Address - Phone:617-332-5015
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2021-09-12
Last Update Date:2021-09-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist