Healthcare Provider Details

I. General information

NPI: 1598956807
Provider Name (Legal Business Name): MELISSA LEW GOODMAN D.P.T.
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

Provider Other Name: MELISSA SUSAN LEW

II. Dates (important events)

Enumeration Date: 08/05/2007
Last Update Date: 08/05/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

CANTRELL CENTER FOR PHYSICAL THERAPY & SPORTS MEDICINE 405 OSIGIAN BLVD
WARNER ROBINS GA
31088-8958
US

IV. Provider business mailing address

CANTRELL CENTER FOR PHYSICAL THERAPY & SPORTS MEDICINE 405 OSIGIAN BLVD
WARNER ROBINS GA
31088-8958
US

V. Phone/Fax

Practice location:
  • Phone: 478-953-3535
  • Fax: 478-953-0353
Mailing address:
  • Phone: 478-953-3535
  • Fax: 478-953-0353

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code225100000X
TaxonomyPhysical Therapist
License Number006861
License Number StateGA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: