Provider Demographics
NPI:1003066721
Name:GOSSETT, WINONA ANN (LMT)
Entity type:Individual
Prefix:MRS
First Name:WINONA
Middle Name:ANN
Last Name:GOSSETT
Suffix:
Gender:F
Credentials:LMT
Other - Prefix:MRS
Other - First Name:KAY
Other - Middle Name:H
Other - Last Name:PEARSON
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:LMT
Mailing Address - Street 1:56 S 9TH ST
Mailing Address - Street 2:
Mailing Address - City:EAST ALTON
Mailing Address - State:IL
Mailing Address - Zip Code:62024-1715
Mailing Address - Country:US
Mailing Address - Phone:618-259-9434
Mailing Address - Fax:
Practice Address - Street 1:56 S 9TH ST
Practice Address - Street 2:
Practice Address - City:EAST ALTON
Practice Address - State:IL
Practice Address - Zip Code:62024-1715
Practice Address - Country:US
Practice Address - Phone:618-259-9434
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2008-09-30
Last Update Date:2008-09-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL227.005178172M00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes172M00000XOther Service ProvidersMechanotherapist