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General NPI Number Information
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NPI Number | 1396415766
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Entity Type | Individual
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Provider Name | RICHARD GOODLUCK PT, DPT
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Gender | Male
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Dates
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Enumeration Date | 09/17/2021
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Last Update Date | 09/17/2021
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Provider Practice Location Address
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Address Line | 1053 MEDICAL CENTER DR STE 151
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City | ORANGE CITY
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State | FL
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Zip | 32763-8261
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Country | US
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Telephone | 386-917-5160
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Fax |
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Provider Business Mailing Address
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Address Line | 860 BROADSTONE WAY APT 201
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City | ALTAMONTE SPRINGS
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State | FL
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Zip | 32714-1638
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Country | US
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Telephone | 973-508-9035
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Fax |
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 2251X0800X
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Taxonomy Name | Orthopedic Physical Therapist
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License Number | PT37678
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License Number State | FL
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