Provider Demographics
NPI:1083067219
Name:GOECKERITZ, LEANNA (ATC)
Entity Type:Individual
Prefix:
First Name:LEANNA
Middle Name:
Last Name:GOECKERITZ
Suffix:
Gender:F
Credentials:ATC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1039 S KING ST
Mailing Address - Street 2:
Mailing Address - City:HONOLULU
Mailing Address - State:HI
Mailing Address - Zip Code:96814-2113
Mailing Address - Country:US
Mailing Address - Phone:808-594-0951
Mailing Address - Fax:808-594-0472
Practice Address - Street 1:1039 S KING ST
Practice Address - Street 2:
Practice Address - City:HONOLULU
Practice Address - State:HI
Practice Address - Zip Code:96814-2113
Practice Address - Country:US
Practice Address - Phone:808-594-0951
Practice Address - Fax:808-594-0472
Is Sole Proprietor?:No
Enumeration Date:2016-07-22
Last Update Date:2016-07-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
HI542255A2300X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2255A2300XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersSpecialist/TechnologistAthletic Trainer