Healthcare Provider Details

I. General information

NPI: 1548244593
Provider Name (Legal Business Name): TIMOTHY C GOULD DPT
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 12/02/2005
Last Update Date: 07/17/2018
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

166 ATHLETIC DR
SHELBURNE VT
05482-4433
US

IV. Provider business mailing address

150 THACHER RD
RICHMOND VT
05477-9703
US

V. Phone/Fax

Practice location:
  • Phone: 802-985-4440
  • Fax: 802-985-4445
Mailing address:
  • Phone: 607-341-8677
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code225100000X
TaxonomyPhysical Therapist
License Number0097216
License Number StateVT

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: