Provider Demographics
NPI:1376755363
Name:GOODE, SYNTHIA LYNN (MSED, ATC)
Entity Type:Individual
Prefix:MS
First Name:SYNTHIA
Middle Name:LYNN
Last Name:GOODE
Suffix:
Gender:F
Credentials:MSED, ATC
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Other - First Name:
Other - Middle Name:
Other - Last Name:
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Mailing Address - Street 1:5312 BLEECKER ST
Mailing Address - Street 2:UNIT 304
Mailing Address - City:VIRGINIA BEACH
Mailing Address - State:VA
Mailing Address - Zip Code:23462-3958
Mailing Address - Country:US
Mailing Address - Phone:757-561-3431
Mailing Address - Fax:757-213-7968
Practice Address - Street 1:184 BUSINESS PARK DR
Practice Address - Street 2:STE 100
Practice Address - City:VIRGINIA BEACH
Practice Address - State:VA
Practice Address - Zip Code:23462-6533
Practice Address - Country:US
Practice Address - Phone:757-561-3431
Practice Address - Fax:757-213-7968
Is Sole Proprietor?:No
Enumeration Date:2007-05-04
Last Update Date:2013-10-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC13292255A2300X
VA1260008612255A2300X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2255A2300XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersSpecialist/TechnologistAthletic Trainer