Healthcare Provider Details

I. General information

NPI: 1215217047
Provider Name (Legal Business Name): TRAVIS R MCGOFF L.M.P
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 08/24/2011
Last Update Date: 08/24/2011
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1125 NW NYE ST SUITE C
PULLMAN WA
99163-3430
US

IV. Provider business mailing address

1125 NW NYE ST SUITE C
PULLMAN WA
99163-3430
US

V. Phone/Fax

Practice location:
  • Phone: 509-332-2225
  • Fax: 509-332-2228
Mailing address:
  • Phone: 509-332-2225
  • Fax: 509-332-2228

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code225700000X
TaxonomyMassage Therapist
License NumberMA60240720
License Number StateWA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: