Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 2251P0200X | Physical Therapist - Pediatrics | 021789-1 | NY |
NPI | 1124271226 |
---|---|
Provider Name | Rachel Naomi Goulson |
First Address | Brooklyn, NY 11219-1012 |
Second Address | Brooklyn, NY 11219-1012 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 03/11/2008 |
Last Update Date | 01/12/2015 |