Provider Demographics
NPI:1093398786
Name:GOUDEAUX HOWARD, XIA (ATC)
Entity Type:Individual
Prefix:
First Name:XIA
Middle Name:
Last Name:GOUDEAUX HOWARD
Suffix:
Gender:F
Credentials:ATC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:103 CANNONBALL LN
Mailing Address - Street 2:
Mailing Address - City:NEWARK
Mailing Address - State:DE
Mailing Address - Zip Code:19702-3097
Mailing Address - Country:US
Mailing Address - Phone:302-588-4203
Mailing Address - Fax:
Practice Address - Street 1:103 CANNONBALL LN
Practice Address - Street 2:
Practice Address - City:NEWARK
Practice Address - State:DE
Practice Address - Zip Code:19702-3097
Practice Address - Country:US
Practice Address - Phone:302-588-4203
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2021-04-30
Last Update Date:2021-04-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
DE20000392162255A2300X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2255A2300XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersSpecialist/TechnologistAthletic Trainer