MEDICARE: JANICE M GOMOKE 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
1	225100000X	Physical Therapist	2305002436	VA

Medicare Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
3	P00233936	OTHER	VA	MEDICARE RR
6	P00871013	OTHER	VA	MEDICARE RAILROAD

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program
2	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program
4	192941	OTHER	VA	BCBS (PHYSICAL THERAPY)
5	7899071	OTHER	VA	AETNA

General Provider Information

NPI Number	:	1508887597
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	JANICE M GOMOKE PT

Provider Business Mailing Address
First Line	:	PO BOX 69030
Second Line	:
City	:	BALTIMORE
State	:	MD
Zip	:	21264-9030
Country	:	US
Telephone Number	:	757-873-2302
Fax Number	:	757-873-2306

Provider Business Practice Location Address
First Line	:	4020 RAINTREE RD STE D
Second Line	:
City	:	CHESAPEAKE
State	:	VA
Zip	:	23321-3749
Country	:	US
Telephone Number	:	757-484-4241
Fax Number	:	757-484-4487

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	07/22/2006
Last Update Date	:	04/16/2018

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Directions to “ JANICE M GOMOKE PT” Practice Location

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