Provider Demographics
NPI:1053736025
Name:GOULD, ELIZABETH MARIE (PTA)
Entity type:Individual
Prefix:MISS
First Name:ELIZABETH
Middle Name:MARIE
Last Name:GOULD
Suffix:
Gender:F
Credentials:PTA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:5 NURSING HOME DR
Mailing Address - Street 2:
Mailing Address - City:CLAREMONT
Mailing Address - State:NH
Mailing Address - Zip Code:03743-7344
Mailing Address - Country:US
Mailing Address - Phone:603-542-9511
Mailing Address - Fax:603-542-7392
Practice Address - Street 1:5 NURSING HOME DR
Practice Address - Street 2:
Practice Address - City:CLAREMONT
Practice Address - State:NH
Practice Address - Zip Code:03743-7344
Practice Address - Country:US
Practice Address - Phone:603-542-9511
Practice Address - Fax:603-542-7392
Is Sole Proprietor?:No
Enumeration Date:2014-02-27
Last Update Date:2014-02-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NH1048225200000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225200000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapy Assistant