Provider Demographics
NPI:1003835125
Name:GOULD, ERICA D (PT)
Entity Type:Individual
Prefix:
First Name:ERICA
Middle Name:D
Last Name:GOULD
Suffix:
Gender:F
Credentials:PT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:5984 NW BAYNARD DR
Mailing Address - Street 2:
Mailing Address - City:PORT ST LUCIE
Mailing Address - State:FL
Mailing Address - Zip Code:34986-3610
Mailing Address - Country:US
Mailing Address - Phone:772-342-4490
Mailing Address - Fax:
Practice Address - Street 1:2959 W MIDWAY RD
Practice Address - Street 2:
Practice Address - City:FORT PIERCE
Practice Address - State:FL
Practice Address - Zip Code:34981-4956
Practice Address - Country:US
Practice Address - Phone:772-342-4490
Practice Address - Fax:772-340-6506
Is Sole Proprietor?:No
Enumeration Date:2006-07-19
Last Update Date:2023-08-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAPT26145225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist