Provider Demographics
NPI:1144866187
Name:GOOCH, JOSHUA JORDAN (MS, LAT, ATC)
Entity type:Individual
Prefix:
First Name:JOSHUA
Middle Name:JORDAN
Last Name:GOOCH
Suffix:
Gender:M
Credentials:MS, LAT, ATC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:55 S BROAD ST
Mailing Address - Street 2:
Mailing Address - City:HUGHESVILLE
Mailing Address - State:PA
Mailing Address - Zip Code:17737-1302
Mailing Address - Country:US
Mailing Address - Phone:412-328-1627
Mailing Address - Fax:
Practice Address - Street 1:55 S BROAD ST
Practice Address - Street 2:
Practice Address - City:HUGHESVILLE
Practice Address - State:PA
Practice Address - Zip Code:17737-1302
Practice Address - Country:US
Practice Address - Phone:412-328-1627
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2019-11-25
Last Update Date:2019-11-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PART0061672255A2300X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2255A2300XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersSpecialist/TechnologistAthletic Trainer