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NPI Code Detail

MEDICARE: MS. ELISA GOULD MS, PT

MEDICARE: MS. ELISA GOULD MS, 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 Therapist022572NY

General Provider Information

NPI Number : 1457617573
Entity Type Code : Individual
Provider Name (Legal Business Name) : MS. ELISA GOULD MS, PT
Provider Business Mailing Address
First Line : 109 BAY 14 ST.
Second Line : ROOM. 403
City : BROOKLYN
State : NY
Zip : 11214
Country : US
Telephone Number : 718-236-9003
Fax Number : 718-259-3042
Provider Business Practice Location Address
First Line : 7115 15TH AVE
Second Line : 102
City : BROOKLYN
State : NY
Zip : 11228-2105
Country : US
Telephone Number : 718-236-9003
Fax Number : 718-259-3042
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 04/03/2012
Last Update Date : 04/03/2012

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