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General NPI Number Information
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NPI Number | 1467450007
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Entity Type | Individual
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Provider Name | MICHAEL JAMES GOODMAN M.P.T.
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Gender | Male
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Dates
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Enumeration Date | 07/08/2005
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Last Update Date | 08/10/2010
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Provider Practice Location Address
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Address Line | 5508 HARBOR AVE.
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City | FREELAND
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State | WA
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Zip | 98249
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Country | US
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Telephone | 360-331-3969
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Fax | 360-331-0152
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Provider Business Mailing Address
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Address Line | PO BOX 958
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City | FREELAND
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State | WA
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Zip | 98249-0958
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Country | US
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Telephone | 360-331-3969
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Fax | 360-331-0152
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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 | 225100000X
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Taxonomy Name | Physical Therapist
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License Number | PT00009038
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License Number State | WA
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