Provider Demographics
NPI:1578059101
Name:GOSHA, DANETTE M (LMT)
Entity Type:Individual
Prefix:MS
First Name:DANETTE
Middle Name:M
Last Name:GOSHA
Suffix:
Gender:F
Credentials:LMT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4700 FM 2920 RD
Mailing Address - Street 2:
Mailing Address - City:SPRING
Mailing Address - State:TX
Mailing Address - Zip Code:77388-3109
Mailing Address - Country:US
Mailing Address - Phone:832-510-6602
Mailing Address - Fax:
Practice Address - Street 1:4700 FM 2920 RD STE 1
Practice Address - Street 2:
Practice Address - City:SPRING
Practice Address - State:TX
Practice Address - Zip Code:77388-3109
Practice Address - Country:US
Practice Address - Phone:832-510-6602
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2018-07-06
Last Update Date:2018-07-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TXMT123016225700000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225700000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersMassage Therapist