MEDICARE: CATHRYN LUCY GOULD PT

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
1	225100000X	Physical Therapist	7316	NC

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program
2	079J5	OTHER	NC	BLUE CROSS, BLUE SHIELD

General Provider Information

NPI Number	:	1306989959
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	CATHRYN LUCY GOULD PT

Provider Business Mailing Address
First Line	:	416 DRY MONIA RD
Second Line	:
City	:	NEW BERN
State	:	NC
Zip	:	28562-9709
Country	:	US
Telephone Number	:	252-229-2510
Fax Number	:	252-514-4512

Provider Business Practice Location Address
First Line	:	416 DRY MONIA RD
Second Line	:
City	:	NEW BERN
State	:	NC
Zip	:	28562-9709
Country	:	US
Telephone Number	:	252-229-2510
Fax Number	:	252-514-4512

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	02/14/2007
Last Update Date	:	07/08/2007

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