Provider Demographics
NPI:1699386854
Name:GOOSIC, MICHAELA E (PTA)
Entity Type:Individual
Prefix:
First Name:MICHAELA
Middle Name:E
Last Name:GOOSIC
Suffix:
Gender:F
Credentials:PTA
Other - Prefix:
Other - First Name:MICHAELA
Other - Middle Name:E
Other - Last Name:JOSLYN
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:PTA
Mailing Address - Street 1:320 SUNFLOWER CIR
Mailing Address - Street 2:
Mailing Address - City:GRAND ISLAND
Mailing Address - State:NE
Mailing Address - Zip Code:68803-3059
Mailing Address - Country:US
Mailing Address - Phone:308-390-5925
Mailing Address - Fax:
Practice Address - Street 1:3119 W FAIDLEY AVE
Practice Address - Street 2:
Practice Address - City:GRAND ISLAND
Practice Address - State:NE
Practice Address - Zip Code:68803-4199
Practice Address - Country:US
Practice Address - Phone:308-384-2333
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2020-08-12
Last Update Date:2020-08-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NE1186225200000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225200000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapy Assistant