Individual
MR. SAMUEL JOSEPH GOUGH
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
Man
Credential
PTA
Contact information
Practice address
3033 SARNO RD, MELBOURNE, FL 32934-7229
(321) 242-6812
Mailing address
825 ARTHUR ST SE, PALM BAY, FL 32909-3756
(321) 514-5129
Taxonomy
Speciality
Code
Description
License number
State
225200000X
Physical Therapy Assistant
Primary
PTA14486
FL
Other
Enumeration date
02/12/2013
Last updated
02/12/2013
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