Healthcare Provider Details

I. General information

NPI: 1790397420
Provider Name (Legal Business Name): STEPHANIE GOOD PT, DPT
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 08/24/2020
Last Update Date: 02/21/2023
Certification Date: 02/21/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

6021 CLEVELAND AVE
COLUMBUS OH
43231-2256
US

IV. Provider business mailing address

720 E BROAD ST STE 102
COLUMBUS OH
43215-3989
US

V. Phone/Fax

Practice location:
  • Phone: 614-895-1090
  • Fax:
Mailing address:
  • Phone: 614-224-1090
  • Fax: 614-224-2042

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code225100000X
TaxonomyPhysical Therapist
License NumberPT018703
License Number StateOH

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: