MEDICARE: TODD GOSK

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	225200000X	Physical Therapy Assistant

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	PTA19068	OTHER	FL	LICENSE #

General Provider Information

NPI Number	:	1821108739
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	TODD GOSK

Provider Business Mailing Address
First Line	:	11624 MEREDITH LN
Second Line	:
City	:	PORT RICHEY
State	:	FL
Zip	:	34668-1533
Country	:	US
Telephone Number	:	727-692-0215
Fax Number	:

Provider Business Practice Location Address
First Line	:	5221 HANFF LN
Second Line	:
City	:	NEW PORT RICHEY
State	:	FL
Zip	:	34652-4226
Country	:	US
Telephone Number	:	727-841-0515
Fax Number	:

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

Provider Enumeration Date	:	08/30/2006
Last Update Date	:	07/08/2007

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Directions to “ TODD GOSK ” Practice Location

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