Provider Demographics
NPI:1235406547
Name:GOSLINE, ELFRIEDA L (PTA)
Entity Type:Individual
Prefix:
First Name:ELFRIEDA
Middle Name:L
Last Name:GOSLINE
Suffix:
Gender:F
Credentials:PTA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1 E 5TH ST
Mailing Address - Street 2:
Mailing Address - City:DULUTH
Mailing Address - State:MN
Mailing Address - Zip Code:55805-1712
Mailing Address - Country:US
Mailing Address - Phone:218-525-2156
Mailing Address - Fax:
Practice Address - Street 1:900 3RD ST
Practice Address - Street 2:
Practice Address - City:FRANKLIN
Practice Address - State:MN
Practice Address - Zip Code:55333-9799
Practice Address - Country:US
Practice Address - Phone:507-557-2211
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2011-11-30
Last Update Date:2011-11-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MNA1037225200000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225200000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapy Assistant