Basic Information
| Provider Information | |||||||||
| NPI: | 1588333975 | ||||||||
| EntityType: | 1 | ||||||||
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| OrganizationName: | |||||||||
| LastName: | GOCKENBACH | ||||||||
| FirstName: | LINDSAY | ||||||||
| MiddleName: | MARIE | ||||||||
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| Credential: | PT, DPT | ||||||||
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| Mailing Information | |||||||||
| Address1: | 233 BELL FORK RD STE E | ||||||||
| Address2: | |||||||||
| City: | JACKSONVILLE | ||||||||
| State: | NC | ||||||||
| PostalCode: | 285406471 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 9102382259 | ||||||||
| FaxNumber: | 8882099322 | ||||||||
| Practice Location | |||||||||
| Address1: | 233 BELL FORK RD STE E | ||||||||
| Address2: | |||||||||
| City: | JACKSONVILLE | ||||||||
| State: | NC | ||||||||
| PostalCode: | 285406471 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 9102382259 | ||||||||
| FaxNumber: | 8882099322 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 09/09/2021 | ||||||||
| LastUpdateDate: | 09/09/2021 | ||||||||
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| ProviderGenderCode: | F | ||||||||
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| IsSoleProprietor: | N | ||||||||
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| NPICertificationDate: | 09/05/2021 | ||||||||
Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 225100000X | Y | Respiratory, Developmental, Rehabilitative and Restorative Service Providers | Physical Therapist |
No ID Information.