Provider Demographics
NPI:1689628315
Name:GOEBEL, NIKKI LYNN (DPT)
Entity Type:Individual
Prefix:
First Name:NIKKI
Middle Name:LYNN
Last Name:GOEBEL
Suffix:
Gender:F
Credentials:DPT
Other - Prefix:
Other - First Name:NIKKI
Other - Middle Name:
Other - Last Name:BECK
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:201 NE PARK PLAZA DR
Mailing Address - Street 2:SUITE 246
Mailing Address - City:VANCOUVER
Mailing Address - State:WA
Mailing Address - Zip Code:98684-5808
Mailing Address - Country:US
Mailing Address - Phone:360-696-1070
Mailing Address - Fax:360-737-0200
Practice Address - Street 1:201 NE PARK PLAZA DR
Practice Address - Street 2:SUITE 246
Practice Address - City:VANCOUVER
Practice Address - State:WA
Practice Address - Zip Code:98684-5808
Practice Address - Country:US
Practice Address - Phone:360-696-1070
Practice Address - Fax:360-737-0200
Is Sole Proprietor?:No
Enumeration Date:2006-05-19
Last Update Date:2015-05-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OR60518225100000X
WA60537555225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist