Healthcare Provider Details

I. General information

NPI: 1831022151
Provider Name (Legal Business Name): CRYSTAL DAWN GOSE PTA
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 06/05/2026
Last Update Date: 06/05/2026
Certification Date: 06/05/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

88 N PLAINS RD
THE PLAINS OH
45780-1162
US

IV. Provider business mailing address

22 S PLAINS RD
THE PLAINS OH
45780-1332
US

V. Phone/Fax

Practice location:
  • Phone: 740-592-7220
  • Fax:
Mailing address:
  • Phone: 740-590-1102
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code225200000X
TaxonomyPhysical Therapy Assistant
License NumberPTA011007
License Number StateOH

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: