Healthcare Provider Details

I. General information

NPI: 1346525458
Provider Name (Legal Business Name): CATHY C GOULD PT
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 10/20/2011
Last Update Date: 10/20/2011
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

218 CHAPIN RD
LEXINGTON SC
29072-2030
US

IV. Provider business mailing address

2222 SULLIVAN TRL
EASTON PA
18040-7958
US

V. Phone/Fax

Practice location:
  • Phone: 803-957-3600
  • Fax: 803-359-6187
Mailing address:
  • Phone: 610-991-2034
  • Fax: 610-438-2046

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code225100000X
TaxonomyPhysical Therapist
License Number453
License Number StateSC

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: