Healthcare Provider Details

I. General information

NPI: 1548305154
Provider Name (Legal Business Name): MARY GOSS PT
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 02/21/2007
Last Update Date: 12/01/2008
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

300 ELMWOOD ST
NORTH ATTLEBORO MA
02760-1304
US

IV. Provider business mailing address

535 S MAIN ST
RANDOLPH MA
02368-5254
US

V. Phone/Fax

Practice location:
  • Phone: 508-695-2280
  • Fax: 508-695-2298
Mailing address:
  • Phone: 781-961-3370
  • Fax: 781-767-7531

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code225100000X
TaxonomyPhysical Therapist
License Number17832
License Number StateMA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: