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NPI Code Detail

MEDICARE: LAUREN GOODELL DPT

MEDICARE: LAUREN GOODELL DPT
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
1225100000XPhysical Therapist043586NY

General Provider Information

NPI Number : 1467098954
Entity Type Code : Individual
Provider Name (Legal Business Name) : LAUREN GOODELL DPT
Provider Business Mailing Address
First Line : PO BOX 725
Second Line :
City : MENDON
State : NY
Zip : 14506-0725
Country : US
Telephone Number : 585-582-6075
Fax Number :
Provider Business Practice Location Address
First Line : 5 FISHER RD
Second Line :
City : ROCHESTER
State : NY
Zip : 14624-3444
Country : US
Telephone Number : 585-247-0270
Fax Number :
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 11/20/2019
Last Update Date : 04/06/2021

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