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General NPI Number Information
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NPI Number | 1578425203
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Entity Type | Individual
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Provider Name | NICOLE GOSS PTA
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Gender | Female
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Dates
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Enumeration Date | 12/01/2025
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Last Update Date | 12/01/2025
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Provider Practice Location Address
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Address Line | 1909 KNICKERBOCKER RD
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City | SAN ANGELO
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State | TX
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Zip | 76904-5523
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Country | US
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Telephone | 325-213-4420
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Fax |
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Provider Business Mailing Address
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Address Line | 120 MEDINA ST
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City | SAN ANGELO
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State | TX
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Zip | 76905-7728
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Country | US
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Telephone | 402-910-9294
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Fax |
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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 | 225200000X
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Taxonomy Name | Physical Therapy Assistant
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License Number | 2185587
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License Number State | TX
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