Provider Demographics
NPI:1235543067
Name:GOSS, BRANDI LYNN (PT, DPT)
Entity Type:Individual
Prefix:
First Name:BRANDI
Middle Name:LYNN
Last Name:GOSS
Suffix:
Gender:F
Credentials:PT, DPT
Other - Prefix:
Other - First Name:BRANDI
Other - Middle Name:LYNN
Other - Last Name:WORKING
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:PT, DPT
Mailing Address - Street 1:1200 CORPORATE DR STE 400
Mailing Address - Street 2:
Mailing Address - City:HOOVER
Mailing Address - State:AL
Mailing Address - Zip Code:35242-5424
Mailing Address - Country:US
Mailing Address - Phone:423-238-7217
Mailing Address - Fax:
Practice Address - Street 1:218 E 20TH ST STE A
Practice Address - Street 2:
Practice Address - City:EUDORA
Practice Address - State:KS
Practice Address - Zip Code:66025-7700
Practice Address - Country:US
Practice Address - Phone:785-542-3333
Practice Address - Fax:785-542-3330
Is Sole Proprietor?:No
Enumeration Date:2014-06-19
Last Update Date:2021-03-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA2305208667225100000X
KS11-06387225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist
Provider Identifiers
StateIdentifier IDID TypeIssuer
KS11-06387OtherLISENCE
VAP01560752OtherMEDICARE RR PTAN
VAC05954OtherMEDICARE GROUP PTAN
VA1235543067OtherMEDICAID QMB PROVIDER ID