Provider Demographics
NPI:1548386139
Name:GONCALVES, ANITA (PT)
Entity Type:Individual
Prefix:
First Name:ANITA
Middle Name:
Last Name:GONCALVES
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 1:720 COOL SPRINGS BLVD
Mailing Address - Street 2:SUITE 300
Mailing Address - City:FRANKLIN
Mailing Address - State:TN
Mailing Address - Zip Code:37067-2626
Mailing Address - Country:US
Mailing Address - Phone:615-778-4066
Mailing Address - Fax:615-778-9114
Practice Address - Street 1:140 CARANDO DR
Practice Address - Street 2:
Practice Address - City:SPRINGFIELD
Practice Address - State:MA
Practice Address - Zip Code:01104-3296
Practice Address - Country:US
Practice Address - Phone:615-778-4066
Practice Address - Fax:615-778-9114
Is Sole Proprietor?:No
Enumeration Date:2007-03-22
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MA10602225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist