Provider Demographics
NPI:1205181682
Name:GOODWIN, JONATHAN STEPHEN (PT)
Entity Type:Individual
Prefix:MR
First Name:JONATHAN
Middle Name:STEPHEN
Last Name:GOODWIN
Suffix:
Gender:M
Credentials:PT
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Mailing Address - Street 1:101 MANNING DR
Mailing Address - Street 2:DEPARTMENT OF PT/OT
Mailing Address - City:CHAPEL HILL
Mailing Address - State:NC
Mailing Address - Zip Code:27514-4220
Mailing Address - Country:US
Mailing Address - Phone:919-843-1890
Mailing Address - Fax:919-966-0348
Practice Address - Street 1:100 SPRUNT ST
Practice Address - Street 2:DEPARTMENT OF PT/OT
Practice Address - City:CHAPEL HILL
Practice Address - State:NC
Practice Address - Zip Code:27517-7811
Practice Address - Country:US
Practice Address - Phone:919-843-2164
Practice Address - Fax:919-843-2195
Is Sole Proprietor?:No
Enumeration Date:2012-07-20
Last Update Date:2014-10-01
Deactivation Date:
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Provider Licenses
StateLicense IDTaxonomies
NCP13718225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist