Healthcare Provider Details

I. General information

NPI: 1679197784
Provider Name (Legal Business Name): MORGAN E GOODWIN DPT
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 06/04/2020
Last Update Date: 07/22/2021
Certification Date: 07/22/2021
Deactivation Date:
Reactivation Date:

III. Provider practice location address

5000 BENTON RD STE 1
BOSSIER CITY LA
71111-6275
US

IV. Provider business mailing address

5000 BENTON RD STE 1
BOSSIER CITY LA
71111-6275
US

V. Phone/Fax

Practice location:
  • Phone: 318-584-7025
  • Fax: 318-703-6885
Mailing address:
  • Phone: 318-584-7025
  • Fax: 318-703-6885

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code2251G0304X
TaxonomyGeriatric Physical Therapist
License Number10607
License Number StateLA
# 2
Primary TaxonomyN
Taxonomy Code2251X0800X
TaxonomyOrthopedic Physical Therapist
License Number
License Number StateNULL
# 3
Primary TaxonomyY
Taxonomy Code2251X0800X
TaxonomyOrthopedic Physical Therapist
License Number10607
License Number StateLA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: