Provider Demographics
NPI:1053824284
Name:GOULD, WHITNEY (DPT)
Entity Type:Individual
Prefix:
First Name:WHITNEY
Middle Name:
Last Name:GOULD
Suffix:
Gender:F
Credentials:DPT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1377 MOTOR PKWY STE 307
Mailing Address - Street 2:
Mailing Address - City:ISLANDIA
Mailing Address - State:NY
Mailing Address - Zip Code:11749-5258
Mailing Address - Country:US
Mailing Address - Phone:631-580-5200
Mailing Address - Fax:631-580-5222
Practice Address - Street 1:23204 COLUBUS ROAD
Practice Address - Street 2:HOMESTEAD PLAZA II
Practice Address - City:COLUMBUS
Practice Address - State:NJ
Practice Address - Zip Code:08022
Practice Address - Country:US
Practice Address - Phone:609-324-1200
Practice Address - Fax:609-324-1444
Is Sole Proprietor?:No
Enumeration Date:2017-11-09
Last Update Date:2017-11-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
40QA01758900225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist