Healthcare Provider Details

I. General information

NPI: 1427996834
Provider Name (Legal Business Name): WESLEY TRAVIS GOODWYN RRT
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 03/24/2026
Last Update Date: 03/24/2026
Certification Date: 03/24/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1250 E MARSHALL ST
RICHMOND VA
23298-5023
US

IV. Provider business mailing address

1250 OLD CREEK LAKE DR
TAPPAHANNOCK VA
22560-5075
US

V. Phone/Fax

Practice location:
  • Phone: 804-356-5745
  • Fax:
Mailing address:
  • Phone: 804-580-1076
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code227900000X
TaxonomyRegistered Respiratory Therapist
License Number
License Number StateVA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: