Provider Demographics
NPI:1033402904
Name:GOLEY, JEFFERY (LMT, MMP)
Entity Type:Individual
Prefix:
First Name:JEFFERY
Middle Name:
Last Name:GOLEY
Suffix:
Gender:M
Credentials:LMT, MMP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3315 81ST STREET SUITE C
Mailing Address - Street 2:
Mailing Address - City:LUBBOCK
Mailing Address - State:TX
Mailing Address - Zip Code:79423
Mailing Address - Country:US
Mailing Address - Phone:806-928-0839
Mailing Address - Fax:
Practice Address - Street 1:3315 81ST ST
Practice Address - Street 2:SUITE C
Practice Address - City:LUBBOCK
Practice Address - State:TX
Practice Address - Zip Code:79423-2049
Practice Address - Country:US
Practice Address - Phone:806-928-0839
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2011-05-25
Last Update Date:2015-12-31
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TXMT110898225700000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225700000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersMassage Therapist