Healthcare Provider Details

I. General information

NPI: 1801988910
Provider Name (Legal Business Name): EDWARD TITUS GOODMAN III PT
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 09/28/2006
Last Update Date: 08/03/2015
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

4825 UNIVERSITY SQ SUITE 9
HUNTSVILLE AL
35816-1826
US

IV. Provider business mailing address

1660 OSCAR PATTERSON RD
NEW MARKET AL
35761-9418
US

V. Phone/Fax

Practice location:
  • Phone: 256-348-2144
  • Fax:
Mailing address:
  • Phone: 256-348-2144
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code225100000X
TaxonomyPhysical Therapist
License NumberPTH4539
License Number StateAL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: