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General NPI Number Information
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NPI Number | 1366194862
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Entity Type | Organization
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Legal Business Name | GOODWIN ELITE ORTHOBIOLOGICS AND WELLNESS PLLC
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Dates
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Enumeration Date | 01/25/2022
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Last Update Date | 05/18/2022
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Provider Practice Location Address
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Address Line | 100 N GREEN VALLEY PKWY STE 325
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City | HENDERSON
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State | NV
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Zip | 89074-6393
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Country | US
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Telephone | 702-722-6030
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Fax |
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Provider Business Mailing Address
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Address Line | 100 N GREEN VALLEY PKWY STE 325
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City | HENDERSON
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State | NV
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Zip | 89074-6393
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Country | US
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Telephone | 702-722-6030
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Fax |
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Authorized Official
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Title or Position | CREDENTILAER
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Name | SANDY FRIDAY
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Credential | CTP
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Telephone | 702-800-8988
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 208100000X
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Taxonomy Name | Physical Medicine & Rehabilitation Physician
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License Number |
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License Number State |
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