Provider Demographics
NPI:1588167225
Name:GOEBEL, ANJA (MA, ATC)
Entity type:Individual
Prefix:
First Name:ANJA
Middle Name:
Last Name:GOEBEL
Suffix:
Gender:F
Credentials:MA, ATC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3535 S BRADLEY CT
Mailing Address - Street 2:
Mailing Address - City:VISALIA
Mailing Address - State:CA
Mailing Address - Zip Code:93292-1778
Mailing Address - Country:US
Mailing Address - Phone:559-625-4418
Mailing Address - Fax:
Practice Address - Street 1:100 E COLLEGE AVE
Practice Address - Street 2:
Practice Address - City:PORTERVILLE
Practice Address - State:CA
Practice Address - Zip Code:93257-6058
Practice Address - Country:US
Practice Address - Phone:559-791-2460
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2018-03-08
Last Update Date:2018-03-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2255A2300XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersSpecialist/TechnologistAthletic Trainer