Provider Demographics
NPI:1770004426
Name:GOECKERMAN, ALLISON LISA (PT,DPT, NCS)
Entity Type:Individual
Prefix:MRS
First Name:ALLISON
Middle Name:LISA
Last Name:GOECKERMAN
Suffix:
Gender:F
Credentials:PT,DPT, NCS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:117 WILLOW GLEN DR
Mailing Address - Street 2:
Mailing Address - City:KENNETT SQUARE
Mailing Address - State:PA
Mailing Address - Zip Code:19348-2545
Mailing Address - Country:US
Mailing Address - Phone:732-599-4597
Mailing Address - Fax:
Practice Address - Street 1:117 WILLOW GLEN DR
Practice Address - Street 2:
Practice Address - City:KENNETT SQUARE
Practice Address - State:PA
Practice Address - Zip Code:19348-2545
Practice Address - Country:US
Practice Address - Phone:732-599-4597
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2017-07-03
Last Update Date:2017-07-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
DEJ1-0003618225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist