Provider Demographics
NPI:1376922906
Name:GOODELL, EMILY
Entity Type:Individual
Prefix:
First Name:EMILY
Middle Name:
Last Name:GOODELL
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:13809 INDUSTRIAL RD
Mailing Address - Street 2:
Mailing Address - City:OMAHA
Mailing Address - State:NE
Mailing Address - Zip Code:68137-1117
Mailing Address - Country:US
Mailing Address - Phone:402-932-7111
Mailing Address - Fax:402-932-6878
Practice Address - Street 1:13809 INDUSTRIAL RD
Practice Address - Street 2:
Practice Address - City:OMAHA
Practice Address - State:NE
Practice Address - Zip Code:68137-1117
Practice Address - Country:US
Practice Address - Phone:402-932-7111
Practice Address - Fax:402-932-6878
Is Sole Proprietor?:Yes
Enumeration Date:2015-05-28
Last Update Date:2019-02-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NE3450225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist