Provider Demographics
NPI:1205017514
Name:GOODMAN PHYSICAL THERAPY
Entity Type:Organization
Organization Name:GOODMAN PHYSICAL THERAPY
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER/P.T.
Authorized Official - Prefix:
Authorized Official - First Name:DEENA
Authorized Official - Middle Name:POLL
Authorized Official - Last Name:GOODMAN
Authorized Official - Suffix:
Authorized Official - Credentials:PT
Authorized Official - Phone:310-441-1102
Mailing Address - Street 1:9854 NATIONAL BLVD # 437
Mailing Address - Street 2:
Mailing Address - City:LOS ANGELES
Mailing Address - State:CA
Mailing Address - Zip Code:90034-2713
Mailing Address - Country:US
Mailing Address - Phone:310-441-1102
Mailing Address - Fax:310-441-1088
Practice Address - Street 1:2001 S BARRINGTON AVE
Practice Address - Street 2:SUITE 119
Practice Address - City:LOS ANGELES
Practice Address - State:CA
Practice Address - Zip Code:90025-5363
Practice Address - Country:US
Practice Address - Phone:310-441-1102
Practice Address - Fax:310-441-1088
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-11-15
Last Update Date:2016-09-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAPT 18437174400000X
CA18437225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical TherapistGroup - Multi-Specialty
No174400000XOther Service ProvidersSpecialistGroup - Multi-Specialty