Healthcare Provider Details

I. General information

NPI: 1598472045
Provider Name (Legal Business Name): SARA GOEDDEL DPT
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 11/03/2022
Last Update Date: 11/03/2022
Certification Date: 11/01/2022
Deactivation Date:
Reactivation Date:

III. Provider practice location address

801 MONTESANO STREET
WESTPORT WA
98595
US

IV. Provider business mailing address

9739 CONCORD HILLS CT
SAINT LOUIS MO
63123-6274
US

V. Phone/Fax

Practice location:
  • Phone: 360-268-0725
  • Fax:
Mailing address:
  • Phone: 314-496-4953
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code225100000X
TaxonomyPhysical Therapist
License Number
License Number State

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: