Healthcare Provider Details

I. General information

NPI: 1467450007
Provider Name (Legal Business Name): MICHAEL JAMES GOODMAN M.P.T.
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 07/08/2005
Last Update Date: 08/10/2010
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

5508 HARBOR AVE.
FREELAND WA
98249
US

IV. Provider business mailing address

PO BOX 958
FREELAND WA
98249-0958
US

V. Phone/Fax

Practice location:
  • Phone: 360-331-3969
  • Fax: 360-331-0152
Mailing address:
  • Phone: 360-331-3969
  • Fax: 360-331-0152

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code225100000X
TaxonomyPhysical Therapist
License NumberPT00009038
License Number StateWA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: