Basic Information
| Provider Information | |||||||||
| NPI: | 1073966768 | ||||||||
| EntityType: | 1 | ||||||||
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| LastName: | GOUGE | ||||||||
| FirstName: | ANGEL | ||||||||
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| Mailing Information | |||||||||
| Address1: | 2112 8TH ST NW APT 926 | ||||||||
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| City: | WASHINGTON | ||||||||
| State: | DC | ||||||||
| PostalCode: | 200018216 | ||||||||
| CountryCode: | US | ||||||||
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| Practice Location | |||||||||
| Address1: | 600 JULIAN LN STE 660 | ||||||||
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| City: | ARDEN | ||||||||
| State: | NC | ||||||||
| PostalCode: | 287047815 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 8286843611 | ||||||||
| FaxNumber: | 8286843612 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 07/18/2016 | ||||||||
| LastUpdateDate: | 04/15/2020 | ||||||||
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| ProviderGenderCode: | F | ||||||||
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| IsSoleProprietor: | N | ||||||||
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| NPICertificationDate: | 04/15/2020 | ||||||||
Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 225100000X | Y | Respiratory, Developmental, Rehabilitative and Restorative Service Providers | Physical Therapist |
No ID Information.