Provider Demographics
NPI:1518311976
Name:GOODMAN, JENNIFER ERIN (LMT)
Entity Type:Individual
Prefix:MISS
First Name:JENNIFER
Middle Name:ERIN
Last Name:GOODMAN
Suffix:
Gender:F
Credentials:LMT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:365 S UPPER ST APT 2
Mailing Address - Street 2:
Mailing Address - City:LEXINGTON
Mailing Address - State:KY
Mailing Address - Zip Code:40508-2590
Mailing Address - Country:US
Mailing Address - Phone:859-338-9996
Mailing Address - Fax:
Practice Address - Street 1:1795 ALYSHEBA WAY STE 4103
Practice Address - Street 2:
Practice Address - City:LEXINGTON
Practice Address - State:KY
Practice Address - Zip Code:40509-2488
Practice Address - Country:US
Practice Address - Phone:859-338-9996
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2016-04-21
Last Update Date:2016-04-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KYBMTMTH00223694172M00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes172M00000XOther Service ProvidersMechanotherapist