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General NPI Number Information
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NPI Number | 1568798437
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Entity Type | Individual
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Provider Name | MICHELLE PATRICIA GOSHERT PT
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Gender | Female
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Dates
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Enumeration Date | 10/27/2009
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Last Update Date | 10/27/2009
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Provider Practice Location Address
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Address Line | 1250 S 18TH ST
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City | FERNANDINA BEACH
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State | FL
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Zip | 32034-1902
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Country | US
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Telephone | 904-321-3500
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Fax | 904-277-0968
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Provider Business Mailing Address
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Address Line | 85690 BOSTICK WOOD DR
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City | FERNANDINA BEACH
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State | FL
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Zip | 32034-8179
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Country | US
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Telephone | 904-548-1174
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Fax | 904-548-1174
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 225100000X
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Taxonomy Name | Physical Therapist
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License Number | PT22741
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License Number State | FL
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