Provider Demographics
NPI:1134337959
Name:GOSSETT, CATHARINE MICHELLE (PTA)
Entity type:Individual
Prefix:
First Name:CATHARINE
Middle Name:MICHELLE
Last Name:GOSSETT
Suffix:
Gender:F
Credentials:PTA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1412 SE 14TH ST
Mailing Address - Street 2:
Mailing Address - City:MINERAL WELLS
Mailing Address - State:TX
Mailing Address - Zip Code:76067-8511
Mailing Address - Country:US
Mailing Address - Phone:817-597-6253
Mailing Address - Fax:
Practice Address - Street 1:320 SW 25TH AVE
Practice Address - Street 2:
Practice Address - City:MINERAL WELLS
Practice Address - State:TX
Practice Address - Zip Code:76067-8244
Practice Address - Country:US
Practice Address - Phone:940-328-6580
Practice Address - Fax:940-328-6550
Is Sole Proprietor?:No
Enumeration Date:2007-05-18
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX2044923225200000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225200000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapy Assistant
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX2044923OtherPTA LICENSE NUMBER