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General NPI Number Information
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NPI Number | 1205017514
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Entity Type | Organization
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Legal Business Name | GOODMAN PHYSICAL THERAPY
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Dates
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Enumeration Date | 11/15/2007
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Last Update Date | 09/14/2016
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Provider Practice Location Address
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Address Line | 2001 S BARRINGTON AVE SUITE 119
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City | LOS ANGELES
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State | CA
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Zip | 90025-5363
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Country | US
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Telephone | 310-441-1102
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Fax | 310-441-1088
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Provider Business Mailing Address
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Address Line | 9854 NATIONAL BLVD # 437
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City | LOS ANGELES
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State | CA
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Zip | 90034-2713
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Country | US
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Telephone | 310-441-1102
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Fax | 310-441-1088
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Authorized Official
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Title or Position | OWNER/P.T.
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Name | DEENA POLL GOODMAN
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Credential | P.T.
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Telephone | 310-441-1102
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 174400000X
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Taxonomy Name | Specialist
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License Number | PT 18437
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License Number State | CA
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Taxonomy #2
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Taxonomy Code | 225100000X
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Taxonomy Name | Physical Therapist
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License Number | 18437
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License Number State | CA
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