Provider Demographics
NPI:1508908120
Name:GOODWIN, JULIA S (MPT)
Entity Type:Individual
Prefix:MS
First Name:JULIA
Middle Name:S
Last Name:GOODWIN
Suffix:
Gender:F
Credentials:MPT
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 5474
Mailing Address - Street 2:
Mailing Address - City:MOHAVE VALLEY
Mailing Address - State:AZ
Mailing Address - Zip Code:86446-5474
Mailing Address - Country:US
Mailing Address - Phone:928-542-3233
Mailing Address - Fax:928-788-4423
Practice Address - Street 1:8450 OLIVE AVE
Practice Address - Street 2:
Practice Address - City:MOHAVE VALLEY
Practice Address - State:AZ
Practice Address - Zip Code:86440-9214
Practice Address - Country:US
Practice Address - Phone:928-768-2507
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2007-02-12
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AZ6868225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist
Provider Identifiers
StateIdentifier IDID TypeIssuer
AZ968919OtherAHCCCS ID NUMBER