MEDICARE: BRITTANY ELISE GOOS PTA

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	2121939	TX

General Provider Information

NPI Number	:	1831542208
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	BRITTANY ELISE GOOS PTA

Provider Business Mailing Address
First Line	:	10961 GATEWAY BLVD W
Second Line	:	SUITE #100
City	:	EL PASO
State	:	TX
Zip	:	79935-4922
Country	:	US
Telephone Number	:	915-245-3131
Fax Number	:

Provider Business Practice Location Address
First Line	:	10961 GATEWAY BLVD W
Second Line	:	SUITE #100
City	:	EL PASO
State	:	TX
Zip	:	79935-4922
Country	:	US
Telephone Number	:	915-245-3131
Fax Number	:

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

Provider Enumeration Date	:	07/20/2016
Last Update Date	:	07/20/2016

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Directions to “ BRITTANY ELISE GOOS PTA” Practice Location

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