Provider Demographics
NPI:1871950824
Name:GOOL, TERESA
Entity type:Individual
Prefix:
First Name:TERESA
Middle Name:
Last Name:GOOL
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 871027
Mailing Address - Street 2:
Mailing Address - City:WASILLA
Mailing Address - State:AK
Mailing Address - Zip Code:99687-1027
Mailing Address - Country:US
Mailing Address - Phone:907-373-3734
Mailing Address - Fax:907-746-8707
Practice Address - Street 1:1901 N HEMMER RD
Practice Address - Street 2:STE 209
Practice Address - City:PALMER
Practice Address - State:AK
Practice Address - Zip Code:99645-9690
Practice Address - Country:US
Practice Address - Phone:907-745-2727
Practice Address - Fax:907-746-8707
Is Sole Proprietor?:Yes
Enumeration Date:2016-01-21
Last Update Date:2016-01-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AK1044225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist