Provider Demographics
NPI:1275012072
Name:GOODALL, ANTHONY DAVID (DPT)
Entity Type:Individual
Prefix:
First Name:ANTHONY
Middle Name:DAVID
Last Name:GOODALL
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 1:615 KOHLER AVE
Mailing Address - Street 2:
Mailing Address - City:OLD FORGE
Mailing Address - State:PA
Mailing Address - Zip Code:18518-1042
Mailing Address - Country:US
Mailing Address - Phone:570-885-3837
Mailing Address - Fax:
Practice Address - Street 1:220 E CENTER HILL RD
Practice Address - Street 2:
Practice Address - City:DALLAS
Practice Address - State:PA
Practice Address - Zip Code:18612-1147
Practice Address - Country:US
Practice Address - Phone:570-675-2300
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2018-08-13
Last Update Date:2018-08-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PAPT0270172251X0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes2251X0800XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical TherapistOrthopedicGroup - Multi-Specialty