Provider Demographics
NPI:1164931374
Name:GOSS, JOANNE BREWSTER (MS, ATC, LAT)
Entity Type:Individual
Prefix:
First Name:JOANNE
Middle Name:BREWSTER
Last Name:GOSS
Suffix:
Gender:F
Credentials:MS, ATC, LAT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1056 LONG DR
Mailing Address - Street 2:
Mailing Address - City:SHERIDAN
Mailing Address - State:WY
Mailing Address - Zip Code:82801-6701
Mailing Address - Country:US
Mailing Address - Phone:307-672-2495
Mailing Address - Fax:
Practice Address - Street 1:1056 LONG DR
Practice Address - Street 2:
Practice Address - City:SHERIDAN
Practice Address - State:WY
Practice Address - Zip Code:82801-6701
Practice Address - Country:US
Practice Address - Phone:307-672-2495
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2017-09-20
Last Update Date:2022-07-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WY402255A2300X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2255A2300XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersSpecialist/TechnologistAthletic Trainer