Provider Demographics
NPI:1003922998
Name:GOOD, MERRILEE HOLMAN (PT)
Entity Type:Individual
Prefix:
First Name:MERRILEE
Middle Name:HOLMAN
Last Name:GOOD
Suffix:
Gender:F
Credentials:PT
Other - Prefix:
Other - First Name:MERRILEE
Other - Middle Name:
Other - Last Name:HOLMAN
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:PT
Mailing Address - Street 1:37624 SE FURY ST
Mailing Address - Street 2:SUITE C-201
Mailing Address - City:SNOQUALMIE
Mailing Address - State:WA
Mailing Address - Zip Code:98065-9680
Mailing Address - Country:US
Mailing Address - Phone:425-292-0223
Mailing Address - Fax:425-292-9225
Practice Address - Street 1:37624 SE FURY ST
Practice Address - Street 2:SUITE C-201
Practice Address - City:SNOQUALMIE
Practice Address - State:WA
Practice Address - Zip Code:98065-9680
Practice Address - Country:US
Practice Address - Phone:425-292-0223
Practice Address - Fax:425-292-9225
Is Sole Proprietor?:No
Enumeration Date:2006-08-22
Last Update Date:2015-10-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA2305204734225100000X
AZ8841174400000X
WA60540642225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist
No174400000XOther Service ProvidersSpecialist