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NPI Code Detail

MEDICARE: GOSHE PHYSICAL THERAPY, INC.

MEDICARE: GOSHE PHYSICAL THERAPY, INC.
Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

# Taxonomy Code Taxonomy License Number License Number State
1225100000XPhysical TherapistPT12761CA

Other Identifiers

# Provider Identifier Provider Identifier Type Provider Identifier State Provider Identifier Issuer
1PT12761OTHERCAPT LISENCE NUMBER

General Provider Information

NPI Number : 1174748693
Entity Type Code : Organization
Provider Name (Legal Business Name) : GOSHE PHYSICAL THERAPY, INC.
Provider Business Mailing Address
First Line : 404 WESTMINSTER AVE # 6
Second Line :
City : NEWPORT BEACH
State : CA
Zip : 92663-4237
Country : US
Telephone Number : 949-646-6863
Fax Number : 949-646-6538
Provider Business Practice Location Address
First Line : 404 WESTMINSTER AVE # 6
Second Line :
City : NEWPORT BEACH
State : CA
Zip : 92663-4237
Country : US
Telephone Number : 949-646-6863
Fax Number : 949-646-6538
Authorized Official
Title or Position : OWNER
Name : LAURIE GOSHE
Credential : P.T.
Telephone Number : 949-646-6863
Provider Enumeration Date : 04/17/2007
Last Update Date : 10/05/2010

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