Provider Demographics
NPI:1225450406
Name:GOOLSBY, SANDRA L (LMT # MT115723)
Entity Type:Individual
Prefix:
First Name:SANDRA
Middle Name:L
Last Name:GOOLSBY
Suffix:
Gender:F
Credentials:LMT # MT115723
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:11675 W BELLFORT ST
Mailing Address - Street 2:APT #123
Mailing Address - City:HOUSTON
Mailing Address - State:TX
Mailing Address - Zip Code:77099-6000
Mailing Address - Country:US
Mailing Address - Phone:832-542-8940
Mailing Address - Fax:
Practice Address - Street 1:11675 W BELLFORT ST
Practice Address - Street 2:APT #123
Practice Address - City:HOUSTON
Practice Address - State:TX
Practice Address - Zip Code:77099-6000
Practice Address - Country:US
Practice Address - Phone:832-542-8940
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2014-01-07
Last Update Date:2014-01-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TXLMT # MT115723225700000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225700000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersMassage Therapist