Provider Demographics
NPI:1376896449
Name:BLOODGOOD, JOHN CARL (PT)
Entity Type:Individual
Prefix:MR
First Name:JOHN
Middle Name:CARL
Last Name:BLOODGOOD
Suffix:
Gender:M
Credentials:PT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:16 ACADEMY ST
Mailing Address - Street 2:
Mailing Address - City:FARMINGDALE
Mailing Address - State:NJ
Mailing Address - Zip Code:07727-1226
Mailing Address - Country:US
Mailing Address - Phone:908-330-5382
Mailing Address - Fax:
Practice Address - Street 1:170 MORRIS AVE
Practice Address - Street 2:SUITE B
Practice Address - City:LONG BRANCH
Practice Address - State:NJ
Practice Address - Zip Code:07740-8214
Practice Address - Country:US
Practice Address - Phone:732-222-7900
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2012-10-26
Last Update Date:2012-10-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ40QA00584900225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist