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General NPI Number Information
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NPI Number | 1629192216
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Entity Type | Individual
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Provider Name | ANGELIA GOODE PT
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Gender | Female
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Dates
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Enumeration Date | 03/19/2007
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Last Update Date | 02/05/2014
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Provider Practice Location Address
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Address Line | 212 MOUNT JOY CHURCH RD
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City | JONESVILLE
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State | SC
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Zip | 29353
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Country | US
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Telephone | 864-301-0995
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Fax |
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Provider Business Mailing Address
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Address Line | 212 MOUNT JOY CHURCH RD
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City | JONESVILLE
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State | SC
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Zip | 29353-2905
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Country | US
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Telephone | 864-301-0995
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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 | 2305204129
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License Number State | VA
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Taxonomy #2
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Taxonomy Code | 225100000X
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Taxonomy Name | Physical Therapist
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License Number | 4808
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License Number State | NC
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