Provider Demographics
NPI:1841253960
Name:GOULD, AMY RALYNN (MAE, ATC, LAT, CES)
Entity type:Individual
Prefix:MRS
First Name:AMY
Middle Name:RALYNN
Last Name:GOULD
Suffix:
Gender:F
Credentials:MAE, ATC, LAT, CES
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:101 EDGEWOOD ST
Mailing Address - Street 2:
Mailing Address - City:SAINT CLAIRSVILLE
Mailing Address - State:OH
Mailing Address - Zip Code:43950-1509
Mailing Address - Country:US
Mailing Address - Phone:304-559-6896
Mailing Address - Fax:
Practice Address - Street 1:10095 BRICK CHURCH RD
Practice Address - Street 2:
Practice Address - City:CAMBRIDGE
Practice Address - State:OH
Practice Address - Zip Code:43725-8550
Practice Address - Country:US
Practice Address - Phone:740-435-2565
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2006-04-10
Last Update Date:2012-05-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OHAT-0024642255A2300X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2255A2300XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersSpecialist/TechnologistAthletic Trainer