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NPI Code Detail

MEDICARE: ERICA D GOULD PT

MEDICARE: ERICA D GOULD PT
Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

# Taxonomy Code Taxonomy License Number License Number State
1225100000XPhysical TherapistPT26145CA

Other Identifiers

# Provider Identifier Provider Identifier Type Provider Identifier State Provider Identifier Issuer
1MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number : 1003835125
Entity Type Code : Individual
Provider Name (Legal Business Name) : ERICA D GOULD PT
Provider Business Mailing Address
First Line : 5984 NW BAYNARD DR
Second Line :
City : PORT ST LUCIE
State : FL
Zip : 34986-3610
Country : US
Telephone Number : 772-342-4490
Fax Number :
Provider Business Practice Location Address
First Line : 2959 W MIDWAY RD
Second Line :
City : FORT PIERCE
State : FL
Zip : 34981-4956
Country : US
Telephone Number : 772-342-4490
Fax Number : 772-340-6506
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 07/19/2006
Last Update Date : 08/03/2023

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