Provider Demographics
NPI:1750811733
Name:GOULDEN, PENNY (PT, DPT)
Entity type:Individual
Prefix:
First Name:PENNY
Middle Name:
Last Name:GOULDEN
Suffix:
Gender:F
Credentials:PT, DPT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:12941 NORTH FWY STE 401
Mailing Address - Street 2:
Mailing Address - City:HOUSTON
Mailing Address - State:TX
Mailing Address - Zip Code:77060-1243
Mailing Address - Country:US
Mailing Address - Phone:832-253-1188
Mailing Address - Fax:832-253-1181
Practice Address - Street 1:815 N VIRGINIA ST
Practice Address - Street 2:
Practice Address - City:PORT LAVACA
Practice Address - State:TX
Practice Address - Zip Code:77979
Practice Address - Country:US
Practice Address - Phone:361-551-2513
Practice Address - Fax:361-551-2528
Is Sole Proprietor?:Yes
Enumeration Date:2017-06-13
Last Update Date:2019-04-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX1202268225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist