Provider Demographics
NPI:1407001340
Name:GOODY, EDITH PHILENE (DPT)
Entity Type:Individual
Prefix:DR
First Name:EDITH
Middle Name:PHILENE
Last Name:GOODY
Suffix:
Gender:F
Credentials:DPT
Other - Prefix:
Other - First Name:EDITH
Other - Middle Name:PHILENE
Other - Last Name:RITTERBAND
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:195 S MIDDLE NECK RD APT 2A
Mailing Address - Street 2:
Mailing Address - City:GREAT NECK
Mailing Address - State:NY
Mailing Address - Zip Code:11021-4622
Mailing Address - Country:US
Mailing Address - Phone:719-351-8447
Mailing Address - Fax:
Practice Address - Street 1:195 S MIDDLE NECK RD APT 2A
Practice Address - Street 2:
Practice Address - City:GREAT NECK
Practice Address - State:NY
Practice Address - Zip Code:11021-4622
Practice Address - Country:US
Practice Address - Phone:516-570-0794
Practice Address - Fax:516-570-0794
Is Sole Proprietor?:Yes
Enumeration Date:2008-11-19
Last Update Date:2019-07-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY030788-1225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist