Provider Demographics
NPI:1770008013
Name:GOYETTE, ALLISON (DPT)
Entity Type:Individual
Prefix:
First Name:ALLISON
Middle Name:
Last Name:GOYETTE
Suffix:
Gender:F
Credentials:DPT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:479 WASHINGTON ST STE 50
Mailing Address - Street 2:
Mailing Address - City:QUINCY
Mailing Address - State:MA
Mailing Address - Zip Code:02169-5895
Mailing Address - Country:US
Mailing Address - Phone:617-536-1161
Mailing Address - Fax:617-536-1165
Practice Address - Street 1:479 WASHINGTON ST STE 50
Practice Address - Street 2:
Practice Address - City:QUINCY
Practice Address - State:MA
Practice Address - Zip Code:02169-5895
Practice Address - Country:US
Practice Address - Phone:617-536-1161
Practice Address - Fax:617-536-1165
Is Sole Proprietor?:No
Enumeration Date:2017-08-08
Last Update Date:2022-01-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MA23098225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist
Provider Identifiers
StateIdentifier IDID TypeIssuer
MA110127760AMedicaid