Provider Demographics
NPI:1528743010
Name:GOEKE, SAMANTHA J (LMT)
Entity type:Individual
Prefix:
First Name:SAMANTHA
Middle Name:J
Last Name:GOEKE
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 1:1944 SUSSEX LN
Mailing Address - Street 2:
Mailing Address - City:COLORADO SPRINGS
Mailing Address - State:CO
Mailing Address - Zip Code:80909-1438
Mailing Address - Country:US
Mailing Address - Phone:971-219-2949
Mailing Address - Fax:
Practice Address - Street 1:2605A W COLORADO AVE STE 215
Practice Address - Street 2:
Practice Address - City:COLORADO SPRINGS
Practice Address - State:CO
Practice Address - Zip Code:80904-3069
Practice Address - Country:US
Practice Address - Phone:971-219-2949
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2023-06-21
Last Update Date:2023-06-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
COMT.0025834225700000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225700000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersMassage Therapist