MEDICARE: KARMEN GOODFELLOW PT

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	225100000X	Physical Therapist	8297	WA

General Provider Information

NPI Number	:	1811415680
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	KARMEN GOODFELLOW PT

Provider Business Mailing Address
First Line	:	800 JASMINE ST
Second Line	:
City	:	OMAK
State	:	WA
Zip	:	98841-9501
Country	:	US
Telephone Number	:	509-826-7666
Fax Number	:

Provider Business Practice Location Address
First Line	:	800 JASMINE ST
Second Line	:
City	:	OMAK
State	:	WA
Zip	:	98841-9501
Country	:	US
Telephone Number	:	509-826-7666
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	08/31/2017
Last Update Date	:	07/21/2022

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Directions to “ KARMEN GOODFELLOW PT” Practice Location

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