Active NPI
Renae Goodell, PTA, LMP
- Physical Therapy Assistant
- Lacey, WA
National Provider Identifier
1861737025
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Physical Therapy Assistant
- License
- 60046677
- Practice address
- 7405 38TH Dr SE
Lacey, WA 98503-7106 - Phone
- (336) 327-8975
- NPI assigned
- Nov 29, 2012
- Sex
- Female
- Sole proprietor
- Yes
NPPES NPI Registry
Registry information is reported by the provider to CMS and is not verified. About this source
Specialties & licenses 2
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Physical Therapy Assistant | 225200000X | 60046677 | WA | Primary |
| Massage Therapist | 225700000X | MA 60453128 | WA |
Addresses
Primary practice location
7405 38TH Dr SE
Lacey, WA 98503-7106
Mailing address
7405 38TH Dr SE
Lacey, WA 98503-7106
Phone (336) 327-8975
Medicare participation
Medicare enrollment files- Medicare fee-for-service enrollment
- Not listed in the public Medicare enrollment file
National Provider Directory
National Provider Directory- Medicare enrollment (NPD)
- Not enrolled
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| 60046677 | WA | MD | Physical Therapy Assistant |
| MA 60453128 | WA | MD | Massage Therapist |
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1354147200000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1411603200000",
"number": "1861737025",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "7405 38TH DR SE",
"city": "LACEY",
"state": "WA",
"postal_code": "985037106",
"telephone_number": "336-327-8975"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "7405 38TH DR SE",
"city": "LACEY",
"state": "WA",
"postal_code": "985037106",
"telephone_number": "336-327-8975"
}
],
"practiceLocations": [],
"basic": {
"last_name": "GOODELL",
"first_name": "RENAE",
"credential": "PTA, LMP",
"sole_proprietor": "YES",
"sex": "F",
"enumeration_date": "2012-11-29",
"last_updated": "2014-09-25",
"status": "A"
},
"taxonomies": [
{
"code": "225200000X",
"taxonomy_group": "",
"desc": "Physical Therapy Assistant",
"state": "WA",
"license": "60046677",
"primary": true
},
{
"code": "225700000X",
"taxonomy_group": "",
"desc": "Massage Therapist",
"state": "WA",
"license": "MA 60453128",
"primary": false
}
],
"identifiers": [],
"endpoints": [],
"other_names": []
}Other providers in Lacey, WA
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Sep 25, 2014; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.