Provider Demographics
NPI:1295844124
Name:GOODWIN, CURTIS
Entity Type:Individual
Prefix:
First Name:CURTIS
Middle Name:
Last Name:GOODWIN
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1315 TIMBERVIEW DR
Mailing Address - Street 2:
Mailing Address - City:ALLEN
Mailing Address - State:TX
Mailing Address - Zip Code:75002-2928
Mailing Address - Country:US
Mailing Address - Phone:469-675-0630
Mailing Address - Fax:
Practice Address - Street 1:375 MUNICIPAL DR
Practice Address - Street 2:STE 108
Practice Address - City:RICHARDSON
Practice Address - State:TX
Practice Address - Zip Code:75080-3559
Practice Address - Country:US
Practice Address - Phone:214-575-4040
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2006-08-30
Last Update Date:2007-11-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX8T7225OtherBLUECROSSBLUESHIELD
TX1129385OtherLICENSE NUMBER
TX1129385OtherLICENSE NUMBER