Provider Demographics
NPI:1124835996
Name:GOBLE, SAMANTHA (LMT)
Entity type:Individual
Prefix:
First Name:SAMANTHA
Middle Name:
Last Name:GOBLE
Suffix:
Gender:F
Credentials:LMT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2315 WESTRIDGE AVE W APT B13
Mailing Address - Street 2:
Mailing Address - City:TACOMA
Mailing Address - State:WA
Mailing Address - Zip Code:98466-8207
Mailing Address - Country:US
Mailing Address - Phone:253-886-1459
Mailing Address - Fax:
Practice Address - Street 1:8909 GRAVELLY LAKE DR SW STE B
Practice Address - Street 2:
Practice Address - City:LAKEWOOD
Practice Address - State:WA
Practice Address - Zip Code:98499-3101
Practice Address - Country:US
Practice Address - Phone:253-584-1144
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2024-12-16
Last Update Date:2024-12-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TXMT134310225700000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225700000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersMassage Therapist