Provider Demographics
NPI:1396415766
Name:GOODLUCK, RICHARD (PT, DPT)
Entity Type:Individual
Prefix:
First Name:RICHARD
Middle Name:
Last Name:GOODLUCK
Suffix:
Gender:M
Credentials:PT, DPT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:860 BROADSTONE WAY APT 201
Mailing Address - Street 2:
Mailing Address - City:ALTAMONTE SPRINGS
Mailing Address - State:FL
Mailing Address - Zip Code:32714-1638
Mailing Address - Country:US
Mailing Address - Phone:973-508-9035
Mailing Address - Fax:
Practice Address - Street 1:1053 MEDICAL CENTER DR STE 151
Practice Address - Street 2:
Practice Address - City:ORANGE CITY
Practice Address - State:FL
Practice Address - Zip Code:32763-8261
Practice Address - Country:US
Practice Address - Phone:386-917-5160
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2021-09-17
Last Update Date:2021-09-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLPT376782251X0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2251X0800XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical TherapistOrthopedic