Provider Demographics
NPI:1033738661
Name:GOODPASTER, JESSICA (MSPT)
Entity Type:Individual
Prefix:
First Name:JESSICA
Middle Name:
Last Name:GOODPASTER
Suffix:
Gender:F
Credentials:MSPT
Other - Prefix:
Other - First Name:JESSICA
Other - Middle Name:
Other - Last Name:MAJOR
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:7717 SUNSET RIDGE PKWY
Mailing Address - Street 2:
Mailing Address - City:INDIANAPOLIS
Mailing Address - State:IN
Mailing Address - Zip Code:46259-7770
Mailing Address - Country:US
Mailing Address - Phone:301-412-5069
Mailing Address - Fax:
Practice Address - Street 1:8325 E SOUTHPORT RD
Practice Address - Street 2:
Practice Address - City:INDIANAPOLIS
Practice Address - State:IN
Practice Address - Zip Code:46259-6833
Practice Address - Country:US
Practice Address - Phone:317-528-6406
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2020-04-14
Last Update Date:2022-11-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IN05009171A2251G0304X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2251G0304XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical TherapistGeriatrics