Provider Demographics
NPI:1285674457
Name:GOULD, BARBARA J (PT)
Entity Type:Individual
Prefix:
First Name:BARBARA
Middle Name:J
Last Name:GOULD
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 1:13640 N PLAZA DEL RIO BLVD
Mailing Address - Street 2:
Mailing Address - City:PEORIA
Mailing Address - State:AZ
Mailing Address - Zip Code:85381-4846
Mailing Address - Country:US
Mailing Address - Phone:623-876-3800
Mailing Address - Fax:623-583-5243
Practice Address - Street 1:14418 W MEEKER BLVD
Practice Address - Street 2:STE 103
Practice Address - City:SUN CITY WEST
Practice Address - State:AZ
Practice Address - Zip Code:85375-5283
Practice Address - Country:US
Practice Address - Phone:623-876-3952
Practice Address - Fax:623-583-5243
Is Sole Proprietor?:No
Enumeration Date:2006-06-07
Last Update Date:2008-01-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AZ128225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist
Provider Identifiers
StateIdentifier IDID TypeIssuer
AZZ76780Medicare PIN
AZZ76781Medicare PIN
AZP00094760Medicare PIN