Provider Demographics
NPI:1386843084
Name:GOODALL, DAVID EUGENE III (LMP)
Entity Type:Individual
Prefix:MR
First Name:DAVID
Middle Name:EUGENE
Last Name:GOODALL
Suffix:III
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 1:200 W MERCER ST
Mailing Address - Street 2:STE. 101
Mailing Address - City:SEATTLE
Mailing Address - State:WA
Mailing Address - Zip Code:98119-3995
Mailing Address - Country:US
Mailing Address - Phone:206-281-7827
Mailing Address - Fax:
Practice Address - Street 1:200 W MERCER ST
Practice Address - Street 2:STE. 101
Practice Address - City:SEATTLE
Practice Address - State:WA
Practice Address - Zip Code:98119-3995
Practice Address - Country:US
Practice Address - Phone:206-281-7827
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2007-07-12
Last Update Date:2010-05-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WAMA00020245225700000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225700000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersMassage Therapist