Provider Demographics
NPI:1508218330
Name:GOODRICH, PAUL (DPT)
Entity Type:Individual
Prefix:
First Name:PAUL
Middle Name:
Last Name:GOODRICH
Suffix:
Gender:M
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:PO BOX 745
Mailing Address - Street 2:
Mailing Address - City:BLANDING
Mailing Address - State:UT
Mailing Address - Zip Code:84511-0745
Mailing Address - Country:US
Mailing Address - Phone:435-678-3869
Mailing Address - Fax:435-678-3769
Practice Address - Street 1:364 W 100 N
Practice Address - Street 2:
Practice Address - City:MONTICELLO
Practice Address - State:UT
Practice Address - Zip Code:84535
Practice Address - Country:US
Practice Address - Phone:435-678-3869
Practice Address - Fax:435-678-3769
Is Sole Proprietor?:No
Enumeration Date:2016-07-05
Last Update Date:2022-08-31
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
UT9381156-8016225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist