Provider Demographics
NPI:1255788469
Name:GOLD, ERICA (DPT)
Entity type:Individual
Prefix:
First Name:ERICA
Middle Name:
Last Name:GOLD
Suffix:
Gender:F
Credentials:DPT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1545 HIGUERA ST
Mailing Address - Street 2:
Mailing Address - City:SAN LUIS OBISPO
Mailing Address - State:CA
Mailing Address - Zip Code:93401
Mailing Address - Country:US
Mailing Address - Phone:805-543-5633
Mailing Address - Fax:805-543-5990
Practice Address - Street 1:16515 MERIDIAN E
Practice Address - Street 2:STE 202B
Practice Address - City:PUYALLUP
Practice Address - State:WA
Practice Address - Zip Code:98375-6251
Practice Address - Country:US
Practice Address - Phone:253-840-5511
Practice Address - Fax:253-840-0835
Is Sole Proprietor?:No
Enumeration Date:2016-05-17
Last Update Date:2021-09-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAPT291190225100000X
WAPT60737919225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist