Provider Demographics
NPI:1477033736
Name:GOODE, TYLER
Entity Type:Individual
Prefix:
First Name:TYLER
Middle Name:
Last Name:GOODE
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:TYLER
Other - Middle Name:
Other - Last Name:GOODE
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:PTA
Mailing Address - Street 1:7578 OLD TARLTON PIKE
Mailing Address - Street 2:
Mailing Address - City:CIRCLEVILLE
Mailing Address - State:OH
Mailing Address - Zip Code:43113-9488
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:417 HILL RD N
Practice Address - Street 2:
Practice Address - City:PICKERINGTON
Practice Address - State:OH
Practice Address - Zip Code:43147-1310
Practice Address - Country:US
Practice Address - Phone:614-788-5181
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2018-08-16
Last Update Date:2018-08-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH073782081S0010X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2081S0010XAllopathic & Osteopathic PhysiciansPhysical Medicine & RehabilitationSports Medicine