Provider Demographics
NPI:1811415680
Name:GOODFELLOW, KARMEN (PT)
Entity Type:Individual
Prefix:
First Name:KARMEN
Middle Name:
Last Name:GOODFELLOW
Suffix:
Gender:F
Credentials:PT
Other - Prefix:
Other - First Name:KARMEN
Other - Middle Name:
Other - Last Name:WALKER
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:PT
Mailing Address - Street 1:800 JASMINE ST
Mailing Address - Street 2:
Mailing Address - City:OMAK
Mailing Address - State:WA
Mailing Address - Zip Code:98841-9501
Mailing Address - Country:US
Mailing Address - Phone:509-826-7666
Mailing Address - Fax:
Practice Address - Street 1:800 JASMINE ST
Practice Address - Street 2:
Practice Address - City:OMAK
Practice Address - State:WA
Practice Address - Zip Code:98841-9501
Practice Address - Country:US
Practice Address - Phone:509-826-7666
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2017-08-31
Last Update Date:2022-07-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WA8297225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist