MEDICARE: HERBERT GOODEN II CLINICAL MASSAGE THE

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	225700000X	Massage Therapist	1833	AL

General Provider Information

NPI Number	:	1518566389
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	HERBERT GOODEN II CLINICAL MASSAGE THE

Provider Business Mailing Address
First Line	:	4963 SULPHUR SPRINGS RD
Second Line	:
City	:	HOOVER
State	:	AL
Zip	:	35226-2083
Country	:	US
Telephone Number	:	205-427-2042
Fax Number	:

Provider Business Practice Location Address
First Line	:	4963 SULPHUR SPRINGS RD
Second Line	:
City	:	HOOVER
State	:	AL
Zip	:	35226-2083
Country	:	US
Telephone Number	:	205-427-2042
Fax Number	:

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

Provider Enumeration Date	:	10/22/2020
Last Update Date	:	10/22/2020

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