Provider Demographics
NPI:1487602942
Name:GOSS, ERICK KIMBALL (DPT)
Entity type:Individual
Prefix:MR
First Name:ERICK
Middle Name:KIMBALL
Last Name:GOSS
Suffix:
Gender:M
Credentials:DPT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1007 DANA DR STE E
Mailing Address - Street 2:
Mailing Address - City:REDDING
Mailing Address - State:CA
Mailing Address - Zip Code:96003-4036
Mailing Address - Country:US
Mailing Address - Phone:530-222-5188
Mailing Address - Fax:530-222-5167
Practice Address - Street 1:1007 DANA DR STE E
Practice Address - Street 2:
Practice Address - City:REDDING
Practice Address - State:CA
Practice Address - Zip Code:96003-4036
Practice Address - Country:US
Practice Address - Phone:530-222-5188
Practice Address - Fax:530-222-5167
Is Sole Proprietor?:Yes
Enumeration Date:2006-05-05
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAPT 26399225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist
Provider Identifiers
StateIdentifier IDID TypeIssuer
CAPT0263990Medicaid
CA0PT263990Medicare ID - Type Unspecified