Healthcare Provider Details

I. General information

NPI: 1861302283
Provider Name (Legal Business Name): JESSE B GOODMAN PT, DPT
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 09/09/2026
Last Update Date: 09/09/2026
Certification Date: 09/09/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1045 W MAIN ST STE D-3
MONTEAGLE TN
37356-7032
US

IV. Provider business mailing address

2840 MONROE FLOYD RD
DECHERD TN
37324-4347
US

V. Phone/Fax

Practice location:
  • Phone: 931-383-9733
  • Fax:
Mailing address:
  • Phone: 931-383-9733
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code225100000X
TaxonomyPhysical Therapist
License Number14733
License Number StateTN

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: