Healthcare Provider Details

I. General information

NPI: 1740395151
Provider Name (Legal Business Name): STACY HOPE GOLDBERG MSPT
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 08/19/2006
Last Update Date: 07/08/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1959 NE PACIFIC ST BOX 356490
SEATTLE WA
98195-6490
US

IV. Provider business mailing address

805 CARLYON AVE SE
OLYMPIA WA
98501-3501
US

V. Phone/Fax

Practice location:
  • Phone: 206-598-4830
  • Fax:
Mailing address:
  • Phone: 206-788-7446
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code225100000X
TaxonomyPhysical Therapist
License NumberPT00009186
License Number StateWA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: