Provider Demographics
NPI:1518735794
Name:MCGOFF, KERRY LYNN (P160320992)
Entity Type:Individual
Prefix:
First Name:KERRY
Middle Name:LYNN
Last Name:MCGOFF
Suffix:
Gender:F
Credentials:P160320992
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:5206 TENNESON RD
Mailing Address - Street 2:
Mailing Address - City:SEDRO WOOLLEY
Mailing Address - State:WA
Mailing Address - Zip Code:98284-8234
Mailing Address - Country:US
Mailing Address - Phone:360-708-2638
Mailing Address - Fax:
Practice Address - Street 1:5206 TENNESON RD
Practice Address - Street 2:
Practice Address - City:SEDRO WOOLLEY
Practice Address - State:WA
Practice Address - Zip Code:98284-8234
Practice Address - Country:US
Practice Address - Phone:360-708-2638
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2023-12-18
Last Update Date:2023-12-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WAP160320992225200000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225200000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapy Assistant