Provider Demographics
NPI:1073788402
Name:JOANNE A. GOLUCH, INC.
Entity Type:Organization
Organization Name:JOANNE A. GOLUCH, INC.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PHYSICAL THERAPIST/PRESIDENT
Authorized Official - Prefix:MS
Authorized Official - First Name:JOANNE
Authorized Official - Middle Name:A
Authorized Official - Last Name:GOLUCH
Authorized Official - Suffix:
Authorized Official - Credentials:PT
Authorized Official - Phone:479-253-1815
Mailing Address - Street 1:266 COUNTY ROAD 3027
Mailing Address - Street 2:
Mailing Address - City:EUREKA SPRINGS
Mailing Address - State:AR
Mailing Address - Zip Code:72632-9721
Mailing Address - Country:US
Mailing Address - Phone:479-253-1815
Mailing Address - Fax:479-363-0000
Practice Address - Street 1:266 COUNTY ROAD 3027
Practice Address - Street 2:
Practice Address - City:EUREKA SPRINGS
Practice Address - State:AR
Practice Address - Zip Code:72632-9721
Practice Address - Country:US
Practice Address - Phone:479-253-1815
Practice Address - Fax:479-363-0000
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2008-04-27
Last Update Date:2008-04-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
ARPT 2620225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical TherapistGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
AR167039742Medicaid