Provider Demographics
NPI:1588349419
Name:GOSPE, MICHAELA (DPT)
Entity type:Individual
Prefix:
First Name:MICHAELA
Middle Name:
Last Name:GOSPE
Suffix:
Gender:F
Credentials:DPT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:14270 W INDIAN SCHOOL RD
Mailing Address - Street 2:
Mailing Address - City:GOODYEAR
Mailing Address - State:AZ
Mailing Address - Zip Code:85395-9202
Mailing Address - Country:US
Mailing Address - Phone:623-440-4445
Mailing Address - Fax:623-440-5558
Practice Address - Street 1:14270 W INDIAN SCHOOL RD
Practice Address - Street 2:
Practice Address - City:GOODYEAR
Practice Address - State:AZ
Practice Address - Zip Code:85395-9202
Practice Address - Country:US
Practice Address - Phone:623-440-4445
Practice Address - Fax:623-440-5558
Is Sole Proprietor?:No
Enumeration Date:2023-06-19
Last Update Date:2023-06-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AZLPT-33036225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist