Provider Demographics
NPI:1275777401
Name:GOSNELL, JULIA LYNNE (PT)
Entity Type:Individual
Prefix:
First Name:JULIA
Middle Name:LYNNE
Last Name:GOSNELL
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 1:1925 B MAYBANK HIGHWAY
Mailing Address - Street 2:PHC REHAB INC.
Mailing Address - City:CHARLESTON
Mailing Address - State:SC
Mailing Address - Zip Code:29412
Mailing Address - Country:US
Mailing Address - Phone:843-766-3888
Mailing Address - Fax:843-766-3478
Practice Address - Street 1:418 B FOLLY ROAD
Practice Address - Street 2:
Practice Address - City:CHARLESTON
Practice Address - State:SC
Practice Address - Zip Code:29412
Practice Address - Country:US
Practice Address - Phone:843-766-3888
Practice Address - Fax:843-766-3478
Is Sole Proprietor?:No
Enumeration Date:2009-05-01
Last Update Date:2009-05-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
SC1908225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist