Provider Demographics
NPI:1417215211
Name:GOODE PODLASEK, ROBIN TRICIA (DPT)
Entity Type:Individual
Prefix:
First Name:ROBIN
Middle Name:TRICIA
Last Name:GOODE PODLASEK
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 1:601 HERITAGE DR
Mailing Address - Street 2:STE 150
Mailing Address - City:JUPITER
Mailing Address - State:FL
Mailing Address - Zip Code:33458-2777
Mailing Address - Country:US
Mailing Address - Phone:561-623-1277
Mailing Address - Fax:561-277-2514
Practice Address - Street 1:601 HERITAGE DR
Practice Address - Street 2:STE 150
Practice Address - City:JUPITER
Practice Address - State:FL
Practice Address - Zip Code:33458-2777
Practice Address - Country:US
Practice Address - Phone:561-623-1277
Practice Address - Fax:561-277-2514
Is Sole Proprietor?:No
Enumeration Date:2012-04-30
Last Update Date:2016-06-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FL26009225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist