Provider Demographics
NPI:1427326602
Name:GOFF, GILBERT BRYANT (LMT)
Entity type:Individual
Prefix:
First Name:GILBERT
Middle Name:BRYANT
Last Name:GOFF
Suffix:
Gender:M
Credentials:LMT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1923 E CANFIELD AVE
Mailing Address - Street 2:
Mailing Address - City:DALTON GARDENS
Mailing Address - State:ID
Mailing Address - Zip Code:83815-9584
Mailing Address - Country:US
Mailing Address - Phone:208-691-4424
Mailing Address - Fax:208-772-8311
Practice Address - Street 1:1034 N 3RD ST
Practice Address - Street 2:
Practice Address - City:COEUR D ALENE
Practice Address - State:ID
Practice Address - Zip Code:83814-3145
Practice Address - Country:US
Practice Address - Phone:208-691-4424
Practice Address - Fax:208-772-8311
Is Sole Proprietor?:No
Enumeration Date:2011-12-02
Last Update Date:2011-12-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WAMA 60233180225700000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225700000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersMassage Therapist