Healthcare Provider Details

I. General information

NPI: 1689333460
Provider Name (Legal Business Name): JULIANNE GOZA ATC, LAT
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 12/09/2021
Last Update Date: 12/09/2021
Certification Date: 12/09/2021
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2800 E SPRING CREEK PKWY
PLANO TX
75074-3300
US

IV. Provider business mailing address

305 RIVER FERN AVE APT 1115
GARLAND TX
75040-2400
US

V. Phone/Fax

Practice location:
  • Phone: 940-881-5630
  • Fax:
Mailing address:
  • Phone: 210-842-1165
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code2081S0010X
TaxonomySports Medicine (Physical Medicine & Rehabilitation) Physician
License NumberAT4869
License Number StateTX
# 2
Primary TaxonomyN
Taxonomy Code2083S0010X
TaxonomySports Medicine (Preventive Medicine) Physician
License NumberAT4869
License Number StateTX
# 3
Primary TaxonomyY
Taxonomy Code2255A2300X
TaxonomyAthletic Trainer
License NumberAT4869
License Number StateTX

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: