Healthcare Provider Details

I. General information

NPI: 1124980701
Provider Name (Legal Business Name): DANIELLE LEIGH GOODMAN
Entity Type: Individual
Gender: Female
Sole Proprietor: N

Provider Other Name: DANIELLE KELLEY

II. Dates (important events)

Enumeration Date: 12/02/2025
Last Update Date: 12/02/2025
Certification Date: 12/02/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

550 FIELDSTOWN RD
GARDENDALE AL
35071-2590
US

IV. Provider business mailing address

3491 STONEY BROOK PL APT 202
FULTONDALE AL
35068-2230
US

V. Phone/Fax

Practice location:
  • Phone: 205-418-1482
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code225100000X
TaxonomyPhysical Therapist
License NumberCP049649T
License Number StateAL
# 2
Primary TaxonomyY
Taxonomy Code225100000X
TaxonomyPhysical Therapist
License Number16757
License Number StateTN

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: