Provider Demographics
NPI:1457478240
Name:GOREE, JACKIE L (MEDICAL MASSAGE THER)
Entity Type:Individual
Prefix:MS
First Name:JACKIE
Middle Name:L
Last Name:GOREE
Suffix:
Gender:F
Credentials:MEDICAL MASSAGE THER
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:9270 TAMERTON WAY
Mailing Address - Street 2:
Mailing Address - City:SACRAMENTO
Mailing Address - State:CA
Mailing Address - Zip Code:95829-9237
Mailing Address - Country:US
Mailing Address - Phone:916-689-6726
Mailing Address - Fax:
Practice Address - Street 1:8437 ELK GROVE FLORIN RD
Practice Address - Street 2:
Practice Address - City:ELK GROVE
Practice Address - State:CA
Practice Address - Zip Code:95624-9518
Practice Address - Country:US
Practice Address - Phone:916-689-6726
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2007-03-25
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA620879225700000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225700000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersMassage Therapist