Healthcare Provider Details

I. General information

NPI: 1740781210
Provider Name (Legal Business Name): PRIYA GOYAL
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 02/21/2018
Last Update Date: 02/21/2018
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

728 S 320TH ST STE G
FEDERAL WAY WA
98003-5255
US

IV. Provider business mailing address

728 S 320TH ST STE G
FEDERAL WAY WA
98003-5255
US

V. Phone/Fax

Practice location:
  • Phone: 206-249-8086
  • Fax:
Mailing address:
  • Phone: 206-249-8086
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code2081S0010X
TaxonomySports Medicine (Physical Medicine & Rehabilitation) Physician
License NumberPT60816112
License Number StateWA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: