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General NPI Number Information
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NPI Number | 1861302283
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Entity Type | Individual
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Provider Name | JESSE B GOODMAN PT, DPT
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Gender | Male
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Dates
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Enumeration Date | 09/09/2026
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Last Update Date | 09/09/2026
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Provider Practice Location Address
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Address Line | 1045 W MAIN ST STE D-3
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City | MONTEAGLE
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State | TN
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Zip | 37356-7032
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Country | US
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Telephone | 931-383-9733
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Fax |
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Provider Business Mailing Address
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Address Line | 2840 MONROE FLOYD RD
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City | DECHERD
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State | TN
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Zip | 37324-4347
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Country | US
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Telephone | 931-383-9733
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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 | 14733
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License Number State | TN
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