Healthcare Provider Details

I. General information

NPI: 1932008554
Provider Name (Legal Business Name): ROBERT WAYNE GOODWIN ORTHOTIC FITTER
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 11/02/2026
Last Update Date: 11/02/2026
Certification Date: 11/02/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

533 N NOVA RD STE 109
ORMOND BEACH FL
32174-4420
US

IV. Provider business mailing address

533 N NOVA RD STE 109
ORMOND BEACH FL
32174-4420
US

V. Phone/Fax

Practice location:
  • Phone: 386-310-4359
  • Fax: 386-310-4394
Mailing address:
  • Phone: 386-310-4359
  • Fax: 386-310-4394

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code225000000X
TaxonomyOrthotic Fitter
License NumberORF302
License Number StateFL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: