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NPI Code Detail

MEDICARE: TIMOTHY C GOULD DPT

MEDICARE:   TIMOTHY C GOULD  DPT
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 Therapist0097216VT

Other Identifiers

# Provider Identifier Provider Identifier Type Provider Identifier State Provider Identifier Issuer
13987644OTHERAETNA
264674501OTHERBCMD
3S8880012OTHERBCDC

General Provider Information

NPI Number : 1548244593
Entity Type Code : Individual
Provider Name (Legal Business Name) : TIMOTHY C GOULD DPT
Provider Business Mailing Address
First Line : 150 THACHER RD
Second Line :
City : RICHMOND
State : VT
Zip : 05477-9703
Country : US
Telephone Number : 607-341-8677
Fax Number :
Provider Business Practice Location Address
First Line : 166 ATHLETIC DR
Second Line :
City : SHELBURNE
State : VT
Zip : 05482-4433
Country : US
Telephone Number : 802-985-4440
Fax Number : 802-985-4445
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 12/02/2005
Last Update Date : 07/17/2018

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