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General NPI Number Information
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NPI Number | 1669069738
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Entity Type | Individual
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Provider Name | JUSTIN R GOODER DPT
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Gender | Male
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Dates
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Enumeration Date | 12/23/2020
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Last Update Date | 03/12/2025
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Provider Practice Location Address
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Address Line | 3141 S MCCLINTOCK DR STE 2
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City | TEMPE
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State | AZ
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Zip | 85282-5682
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Country | US
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Telephone | 480-566-8125
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Fax | 480-566-8126
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Provider Business Mailing Address
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Address Line | 2122 YORK RD STE 300
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City | OAK BROOK
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State | IL
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Zip | 60523-1925
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Country | US
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Telephone | 630-575-6250
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Fax | 630-575-7450
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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 | LPT-31741
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License Number State | AZ
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