Healthcare Provider Details

I. General information

NPI: 1780612002
Provider Name (Legal Business Name): KATHLEEN MARY FOX GOODE PT
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 06/28/2006
Last Update Date: 10/29/2014
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

12 E 46TH ST FL 8 SUITE 2
NEW YORK NY
10017-2418
US

IV. Provider business mailing address

12 E 46TH ST # 8FL
NEW YORK NY
10017-2418
US

V. Phone/Fax

Practice location:
  • Phone: 212-499-0848
  • Fax: 212-499-0753
Mailing address:
  • Phone: 212-499-0876
  • Fax: 212-953-1353

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code225100000X
TaxonomyPhysical Therapist
License Number020800-1
License Number StateNY

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: