Provider Demographics
NPI:1356659791
Name:GOECKEL, ABIGAIL LOUISE
Entity Type:Individual
Prefix:
First Name:ABIGAIL
Middle Name:LOUISE
Last Name:GOECKEL
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4712 SW 6TH AVE
Mailing Address - Street 2:
Mailing Address - City:TOPEKA
Mailing Address - State:KS
Mailing Address - Zip Code:66606-2272
Mailing Address - Country:US
Mailing Address - Phone:785-272-6510
Mailing Address - Fax:785-271-9430
Practice Address - Street 1:4712 SW 6TH AVE
Practice Address - Street 2:
Practice Address - City:TOPEKA
Practice Address - State:KS
Practice Address - Zip Code:66606-2272
Practice Address - Country:US
Practice Address - Phone:785-272-6510
Practice Address - Fax:785-271-9430
Is Sole Proprietor?:Yes
Enumeration Date:2010-09-20
Last Update Date:2010-09-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KS14-02047225200000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225200000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapy Assistant
Provider Identifiers
StateIdentifier IDID TypeIssuer
KS14-02047OtherPHYSICAL THERAPIST ASSISTANT