Provider Demographics
NPI:1548305154
Name:GOSS, MARY (PT)
Entity type:Individual
Prefix:
First Name:MARY
Middle Name:
Last Name:GOSS
Suffix:
Gender:F
Credentials:PT
Other - Prefix:
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Other - Middle Name:
Other - Last Name:
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Mailing Address - Street 1:535 S MAIN ST
Mailing Address - Street 2:
Mailing Address - City:RANDOLPH
Mailing Address - State:MA
Mailing Address - Zip Code:02368-5254
Mailing Address - Country:US
Mailing Address - Phone:781-961-3370
Mailing Address - Fax:781-767-7531
Practice Address - Street 1:300 ELMWOOD ST
Practice Address - Street 2:
Practice Address - City:NORTH ATTLEBORO
Practice Address - State:MA
Practice Address - Zip Code:02760-1304
Practice Address - Country:US
Practice Address - Phone:508-695-2280
Practice Address - Fax:508-695-2298
Is Sole Proprietor?:No
Enumeration Date:2007-02-21
Last Update Date:2008-12-01
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
MA17832225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist