Healthcare Provider Details

I. General information

NPI: 1215852074
Provider Name (Legal Business Name): EMMA GOSSER PT, DPT
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 08/11/2026
Last Update Date: 08/11/2026
Certification Date: 08/11/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

123 SW COLUMBIA ST STE 100
BEND OR
97702-3609
US

IV. Provider business mailing address

123 SW COLUMBIA ST STE 100
BEND OR
97702-3609
US

V. Phone/Fax

Practice location:
  • Phone: 541-241-3061
  • Fax: 541-243-1313
Mailing address:
  • Phone: 541-241-3061
  • Fax: 541-243-1313

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code225100000X
TaxonomyPhysical Therapist
License Number66211
License Number StateOR

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: