Provider Demographics
NPI:1548244593
Name:GOULD, TIMOTHY C (DPT)
Entity Type:Individual
Prefix:
First Name:TIMOTHY
Middle Name:C
Last Name:GOULD
Suffix:
Gender:M
Credentials:DPT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:150 THACHER RD
Mailing Address - Street 2:
Mailing Address - City:RICHMOND
Mailing Address - State:VT
Mailing Address - Zip Code:05477-9703
Mailing Address - Country:US
Mailing Address - Phone:607-341-8677
Mailing Address - Fax:
Practice Address - Street 1:166 ATHLETIC DR
Practice Address - Street 2:
Practice Address - City:SHELBURNE
Practice Address - State:VT
Practice Address - Zip Code:05482-4433
Practice Address - Country:US
Practice Address - Phone:802-985-4440
Practice Address - Fax:802-985-4445
Is Sole Proprietor?:No
Enumeration Date:2005-12-02
Last Update Date:2018-07-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VT0097216225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist
Provider Identifiers
StateIdentifier IDID TypeIssuer
3987644OtherAETNA
64674501OtherBCMD
S8880012OtherBCDC
3987644OtherAETNA
NYRB6712Medicare PIN