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General NPI Number Information
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NPI Number | 1891278685
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Entity Type | Individual
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Provider Name | ERICA LYNN GOSS PTA
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Gender | Female
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Dates
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Enumeration Date | 09/08/2018
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Last Update Date | 09/08/2018
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Provider Practice Location Address
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Address Line | 4400 WALNUT ST
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City | GREENVILLE
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State | TX
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Zip | 75401-5586
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Country | US
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Telephone | 872-990-3455
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Fax |
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Provider Business Mailing Address
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Address Line | 5402 KAYWAY DR
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City | GREENVILLE
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State | TX
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Zip | 75402-6410
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Country | US
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Telephone | 903-522-2933
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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 | 208100000X
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Taxonomy Name | Physical Medicine & Rehabilitation Physician
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License Number | 2122837
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License Number State | TX
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