Provider Demographics
NPI:1407526122
Name:GOODWIN, PAIGE (DPT)
Entity Type:Individual
Prefix:
First Name:PAIGE
Middle Name:
Last Name:GOODWIN
Suffix:
Gender:F
Credentials:DPT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1104 SALAMANCA ST NW
Mailing Address - Street 2:
Mailing Address - City:LOS RANCHOS
Mailing Address - State:NM
Mailing Address - Zip Code:87107-5626
Mailing Address - Country:US
Mailing Address - Phone:505-908-0717
Mailing Address - Fax:505-346-0562
Practice Address - Street 1:2501 RIO GRANDE BLVD NW
Practice Address - Street 2:
Practice Address - City:ALBUQUERQUE
Practice Address - State:NM
Practice Address - Zip Code:87104-3221
Practice Address - Country:US
Practice Address - Phone:505-908-0717
Practice Address - Fax:505-346-0562
Is Sole Proprietor?:No
Enumeration Date:2021-09-14
Last Update Date:2021-09-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NMPT5942225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist