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NPI Code Detail

MEDICARE: ANNA GOMOLKA PTA

MEDICARE: ANNA GOMOLKA PTA
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
1225200000XPhysical Therapy AssistantPTA00469RI
2225200000XPhysical Therapy Assistant4051MA

General Provider Information

NPI Number : 1366651994
Entity Type Code : Individual
Provider Name (Legal Business Name) : ANNA GOMOLKA PTA
Provider Business Mailing Address
First Line : 12 ANGELL RD
Second Line :
City : LINCOLN
State : RI
Zip : 02865-4736
Country : US
Telephone Number : 401-723-6150
Fax Number :
Provider Business Practice Location Address
First Line : 70 GILL AVE
Second Line :
City : PAWTUCKET
State : RI
Zip : 02861-4315
Country : US
Telephone Number : 781-356-1016
Fax Number :
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 05/21/2007
Last Update Date : 04/27/2022

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