MEDICARE: MS. MARCIA IONI GOODEN PT

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	5616	FL

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	Y081D	OTHER	FL	BLUECROSS/BLUESHEILD

General Provider Information

NPI Number	:	1821069543
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MS. MARCIA IONI GOODEN PT

Provider Business Mailing Address
First Line	:	17081 MIRAMAR PKWY
Second Line	:	#373
City	:	MIRAMAR
State	:	FL
Zip	:	33027-4564
Country	:	US
Telephone Number	:	305-467-7249
Fax Number	:	954-447-9742

Provider Business Practice Location Address
First Line	:	501 GOLDEN ISLES DR
Second Line	:	SUITE 204 A-3
City	:	HALLANDALE BEACH
State	:	FL
Zip	:	33009-4729
Country	:	US
Telephone Number	:	305-467-7249
Fax Number	:

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

Provider Enumeration Date	:	01/30/2006
Last Update Date	:	07/08/2007

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