Provider Demographics
NPI:1811284961
Name:GOLDRICK, STEPHEN BRENT (PT, DPT, CSCS)
Entity type:Individual
Prefix:DR
First Name:STEPHEN
Middle Name:BRENT
Last Name:GOLDRICK
Suffix:
Gender:M
Credentials:PT, DPT, CSCS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
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Other - Credentials:
Mailing Address - Street 1:19319 7TH AVE NE
Mailing Address - Street 2:SUITE #100
Mailing Address - City:POULSBO
Mailing Address - State:WA
Mailing Address - Zip Code:98370-7442
Mailing Address - Country:US
Mailing Address - Phone:360-598-3764
Mailing Address - Fax:360-598-3282
Practice Address - Street 1:2400 NW MYHRE RD STE 102
Practice Address - Street 2:
Practice Address - City:SILVERDALE
Practice Address - State:WA
Practice Address - Zip Code:98383-7672
Practice Address - Country:US
Practice Address - Phone:360-613-1834
Practice Address - Fax:360-613-2716
Is Sole Proprietor?:No
Enumeration Date:2011-07-08
Last Update Date:2011-07-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WAPT60214791225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist