MEDICARE: MICHAEL JAMES GOODMAN M.P.T.

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	PT00009038	WA

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	0167321	OTHER	WA	DEPT. LABOR & INDUSTRIES
2	4232GO	OTHER	WA	REGENCE BLUESHIELD
3	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program
4	292104132	OTHER	WA	TRICARE

General Provider Information

NPI Number	:	1467450007
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MICHAEL JAMES GOODMAN M.P.T.

Provider Business Mailing Address
First Line	:	PO BOX 958
Second Line	:
City	:	FREELAND
State	:	WA
Zip	:	98249-0958
Country	:	US
Telephone Number	:	360-331-3969
Fax Number	:	360-331-0152

Provider Business Practice Location Address
First Line	:	5508 HARBOR AVE.
Second Line	:
City	:	FREELAND
State	:	WA
Zip	:	98249
Country	:	US
Telephone Number	:	360-331-3969
Fax Number	:	360-331-0152

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

Provider Enumeration Date	:	07/08/2005
Last Update Date	:	08/10/2010

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