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General NPI Number Information
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NPI Number | 1619447752
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Entity Type | Individual
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Provider Name | JODY LYNN GOODSON PT
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Gender | Female
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Dates
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Enumeration Date | 12/02/2018
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Last Update Date | 12/02/2018
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Provider Practice Location Address
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Address Line | 4066 RED ARROW HWY STE A
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City | SAINT JOSEPH
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State | MI
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Zip | 49085-9209
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Country | US
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Telephone | 269-408-0494
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Fax | 269-408-0492
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Provider Business Mailing Address
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Address Line | 8833 BEECHWOOD CT
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City | BERRIEN CENTER
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State | MI
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Zip | 49102-8721
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Country | US
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Telephone | 269-357-3737
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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 | 225100000X
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Taxonomy Name | Physical Therapist
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License Number | 5501013037
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License Number State | MI
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