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General NPI Number Information
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NPI Number | 1538402649
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Entity Type | Individual
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Provider Name | BRIDGID MARIE GOODE LMT
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Gender | Female
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Dates
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Enumeration Date | 03/27/2013
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Last Update Date | 05/01/2025
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Provider Practice Location Address
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Address Line | 5354 VIVERA LN
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City | JACKSONVILLE
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State | FL
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Zip | 32244-6901
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Country | US
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Telephone | 904-489-9708
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Fax |
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Provider Business Mailing Address
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Address Line | 5140 DEL REY BLVD
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City | LAS CRUCES
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State | NM
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Zip | 88012-7331
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Country | US
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Telephone | 516-532-5611
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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 | 225700000X
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Taxonomy Name | Massage Therapist
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License Number | MT-2024-0025
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License Number State | NM
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Taxonomy #2
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Taxonomy Code | 225700000X
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Taxonomy Name | Massage Therapist
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License Number | MA106040
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License Number State | FL
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Taxonomy #3
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Taxonomy Code | 174400000X
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Taxonomy Name | Specialist
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License Number | 7430
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License Number State | NM
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