Healthcare Provider Details

I. General information

NPI: 1205017514
Provider Name (Legal Business Name): GOODMAN PHYSICAL THERAPY
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 11/15/2007
Last Update Date: 09/14/2016
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2001 S BARRINGTON AVE SUITE 119
LOS ANGELES CA
90025-5363
US

IV. Provider business mailing address

9854 NATIONAL BLVD # 437
LOS ANGELES CA
90034-2713
US

V. Phone/Fax

Practice location:
  • Phone: 310-441-1102
  • Fax: 310-441-1088
Mailing address:
  • Phone: 310-441-1102
  • Fax: 310-441-1088

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code174400000X
TaxonomySpecialist
License NumberPT 18437
License Number StateCA
# 2
Primary TaxonomyY
Taxonomy Code225100000X
TaxonomyPhysical Therapist
License Number18437
License Number StateCA

VIII. Authorized Official

Name: DEENA POLL GOODMAN
Title or Position: OWNER/P.T.
Credential: P.T.
Phone: 310-441-1102