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General NPI Number Information
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NPI Number | 1033402904
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Entity Type | Individual
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Provider Name | JEFFERY GOLEY L.M.T., M.M.P.
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Gender | Male
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Dates
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Enumeration Date | 05/25/2011
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Last Update Date | 12/31/2015
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Provider Practice Location Address
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Address Line | 3315 81ST ST SUITE C
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City | LUBBOCK
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State | TX
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Zip | 79423-2049
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Country | US
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Telephone | 806-928-0839
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Fax |
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Provider Business Mailing Address
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Address Line | 3315 81ST STREET SUITE C
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City | LUBBOCK
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State | TX
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Zip | 79423
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Country | US
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Telephone | 806-928-0839
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Fax |
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 225700000X
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Taxonomy Name | Massage Therapist
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License Number | MT110898
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License Number State | TX
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