Provider Demographics
NPI:1215217047
Name:MCGOFF, TRAVIS R (LMP)
Entity Type:Individual
Prefix:
First Name:TRAVIS
Middle Name:R
Last Name:MCGOFF
Suffix:
Gender:M
Credentials:LMP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1125 NW NYE ST
Mailing Address - Street 2:SUITE C
Mailing Address - City:PULLMAN
Mailing Address - State:WA
Mailing Address - Zip Code:99163-3430
Mailing Address - Country:US
Mailing Address - Phone:509-332-2225
Mailing Address - Fax:509-332-2228
Practice Address - Street 1:1125 NW NYE ST
Practice Address - Street 2:SUITE C
Practice Address - City:PULLMAN
Practice Address - State:WA
Practice Address - Zip Code:99163-3430
Practice Address - Country:US
Practice Address - Phone:509-332-2225
Practice Address - Fax:509-332-2228
Is Sole Proprietor?:Yes
Enumeration Date:2011-08-24
Last Update Date:2011-08-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WAMA60240720225700000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225700000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersMassage Therapist