MEDICARE: KEVIN GOODHUE

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	225100000X	Physical Therapist	054832	NY

General Provider Information

NPI Number	:	1033077714
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	KEVIN GOODHUE

Provider Business Mailing Address
First Line	:	47 RAINTREE IS
Second Line	:
City	:	TONAWANDA
State	:	NY
Zip	:	14150-9508
Country	:	US
Telephone Number	:
Fax Number	:

Provider Business Practice Location Address
First Line	:	64 HAGER ST
Second Line	:
City	:	BUFFALO
State	:	NY
Zip	:	14208-1327
Country	:	US
Telephone Number	:	716-886-4377
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	01/12/2026
Last Update Date	:	01/12/2026

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Directions to “ KEVIN GOODHUE ” Practice Location

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