Individual
LARRY CHRISTOPHER GOUGH
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
Man
Credential
PTA
Contact information
Practice address
3650 S INTERSTATE 35 E, WAXAHACHIE, TX 75165
(972) 937-7320
Mailing address
3650 S INTERSTATE 35 E, WAXAHACHIE, TX 75165
(972) 937-7320
Taxonomy
Speciality
Code
Description
License number
State
208100000X
Physical Medicine & Rehabilitation Physician
Primary
2074909
TX
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
2074909
PHYSICAL THERAPY ASSISTANT LICENSE
TX
Enumeration date
08/30/2018
Last updated
08/30/2018
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