Provider Demographics
NPI:1023568680
Name:GOODMAN, JAY DREW (PT, SCS)
Entity Type:Individual
Prefix:MR
First Name:JAY
Middle Name:DREW
Last Name:GOODMAN
Suffix:
Gender:M
Credentials:PT, SCS
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Mailing Address - Street 1:1603 HILLSBOROUGH ST
Mailing Address - Street 2:WAKEMED AT ALEXANDER YMCA
Mailing Address - City:RALEIGH
Mailing Address - State:NC
Mailing Address - Zip Code:27605-1638
Mailing Address - Country:US
Mailing Address - Phone:919-350-3800
Mailing Address - Fax:919-838-5379
Practice Address - Street 1:1603 HILLSBOROUGH ST
Practice Address - Street 2:1603 HILLSBOROUGH STREET
Practice Address - City:RALEIGH
Practice Address - State:NC
Practice Address - Zip Code:27605-1638
Practice Address - Country:US
Practice Address - Phone:919-350-3800
Practice Address - Fax:919-838-5379
Is Sole Proprietor?:Yes
Enumeration Date:2016-10-07
Last Update Date:2016-10-07
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
NCP5645208100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208100000XAllopathic & Osteopathic PhysiciansPhysical Medicine & Rehabilitation