Provider Demographics
NPI:1205655131
Name:GOBLE, DESTINY ANASTASIA (LMT, CEMFT)
Entity type:Individual
Prefix:
First Name:DESTINY
Middle Name:ANASTASIA
Last Name:GOBLE
Suffix:
Gender:F
Credentials:LMT, CEMFT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:119 MADISON ST
Mailing Address - Street 2:
Mailing Address - City:ALEXANDER CITY
Mailing Address - State:AL
Mailing Address - Zip Code:35010-2525
Mailing Address - Country:US
Mailing Address - Phone:256-487-1352
Mailing Address - Fax:
Practice Address - Street 1:119 MADISON ST
Practice Address - Street 2:
Practice Address - City:ALEXANDER CITY
Practice Address - State:AL
Practice Address - Zip Code:35010-2525
Practice Address - Country:US
Practice Address - Phone:256-487-1352
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2024-10-08
Last Update Date:2024-10-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AL5957225700000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225700000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersMassage Therapist