Provider Demographics
NPI:1114217783
Name:GOODSON, KAREN DAVIS (PTA)
Entity Type:Individual
Prefix:
First Name:KAREN
Middle Name:DAVIS
Last Name:GOODSON
Suffix:
Gender:F
Credentials:PTA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:212 HOSPITAL DR
Mailing Address - Street 2:SUITE B
Mailing Address - City:FAIRHOPE
Mailing Address - State:AL
Mailing Address - Zip Code:36532-2058
Mailing Address - Country:US
Mailing Address - Phone:251-279-1640
Mailing Address - Fax:
Practice Address - Street 1:212 HOSPITAL DR
Practice Address - Street 2:SUITE B
Practice Address - City:FAIRHOPE
Practice Address - State:AL
Practice Address - Zip Code:36532-2058
Practice Address - Country:US
Practice Address - Phone:251-279-1640
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2011-04-15
Last Update Date:2011-04-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AL1068225200000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225200000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapy Assistant