Provider Demographics
NPI:1073891388
Name:GOODWIN, STEVEN THOMAS (DPT)
Entity Type:Individual
Prefix:
First Name:STEVEN
Middle Name:THOMAS
Last Name:GOODWIN
Suffix:
Gender:M
Credentials:DPT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1003 HIGHLAND AVE
Mailing Address - Street 2:
Mailing Address - City:WILMINGTON
Mailing Address - State:DE
Mailing Address - Zip Code:19809
Mailing Address - Country:US
Mailing Address - Phone:302-377-8015
Mailing Address - Fax:
Practice Address - Street 1:3623 SILVERSIDE RD
Practice Address - Street 2:
Practice Address - City:WILMINGTON
Practice Address - State:DE
Practice Address - Zip Code:19810-5101
Practice Address - Country:US
Practice Address - Phone:302-529-1911
Practice Address - Fax:302-529-1916
Is Sole Proprietor?:Yes
Enumeration Date:2011-08-03
Last Update Date:2011-08-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
DEJT-0002721225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist