Provider Demographics
NPI:1225111297
Name:GOSS, CYNTHIA A (PT)
Entity Type:Individual
Prefix:
First Name:CYNTHIA
Middle Name:A
Last Name:GOSS
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 1:919 OKLAHOMA BLVD
Mailing Address - Street 2:
Mailing Address - City:ALVA
Mailing Address - State:OK
Mailing Address - Zip Code:73717-2627
Mailing Address - Country:US
Mailing Address - Phone:580-327-3331
Mailing Address - Fax:580-327-3314
Practice Address - Street 1:919 OKLAHOMA BLVD
Practice Address - Street 2:
Practice Address - City:ALVA
Practice Address - State:OK
Practice Address - Zip Code:73717-2627
Practice Address - Country:US
Practice Address - Phone:580-327-3331
Practice Address - Fax:580-327-3314
Is Sole Proprietor?:No
Enumeration Date:2006-10-23
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OKPT2814225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist