Provider Demographics
NPI:1467649889
Name:GOFF, NATALEE NICOLE (LMT)
Entity Type:Individual
Prefix:
First Name:NATALEE
Middle Name:NICOLE
Last Name:GOFF
Suffix:
Gender:F
Credentials:LMT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:16220 N 7TH ST APT 2202
Mailing Address - Street 2:
Mailing Address - City:PHOENIX
Mailing Address - State:AZ
Mailing Address - Zip Code:85022-6686
Mailing Address - Country:US
Mailing Address - Phone:602-332-2774
Mailing Address - Fax:
Practice Address - Street 1:16220 N 7TH ST APT 2202
Practice Address - Street 2:
Practice Address - City:PHOENIX
Practice Address - State:AZ
Practice Address - Zip Code:85022-6686
Practice Address - Country:US
Practice Address - Phone:602-332-2774
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2007-09-30
Last Update Date:2007-09-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AZMT-07432225700000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225700000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersMassage Therapist