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NPI Code Detail

MEDICARE: JASMIN E SANDRIDGE GOOD DPT

MEDICARE: JASMIN E SANDRIDGE GOOD 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 TherapistPTHAL

General Provider Information

NPI Number : 1588960645
Entity Type Code : Individual
Provider Name (Legal Business Name) : JASMIN E SANDRIDGE GOOD DPT
Provider Business Mailing Address
First Line : 2004 MAX LUTHER DR NW
Second Line :
City : HUNTSVILLE
State : AL
Zip : 35810-3800
Country : US
Telephone Number : 256-852-9290
Fax Number : 256-852-1141
Provider Business Practice Location Address
First Line : 2004 MAX LUTHER DR NW
Second Line :
City : HUNTSVILLE
State : AL
Zip : 35810-3800
Country : US
Telephone Number : 256-852-9290
Fax Number : 256-852-1141
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 02/07/2011
Last Update Date : 10/25/2011

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Directions to “ JASMIN E SANDRIDGE GOOD DPT” Practice Location

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