Provider Demographics
NPI:1528386067
Name:GOODBODY PHYSICAL THERAPY & CHIROPRACTIC PLLC
Entity Type:Organization
Organization Name:GOODBODY PHYSICAL THERAPY & CHIROPRACTIC PLLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:JOHN
Authorized Official - Middle Name:W
Authorized Official - Last Name:GOODBODY
Authorized Official - Suffix:
Authorized Official - Credentials:PT, DC
Authorized Official - Phone:585-388-1110
Mailing Address - Street 1:481 PENBROOKE DR
Mailing Address - Street 2:SUITE 6
Mailing Address - City:PENFIELD
Mailing Address - State:NY
Mailing Address - Zip Code:14526-2044
Mailing Address - Country:US
Mailing Address - Phone:585-388-1110
Mailing Address - Fax:585-388-1124
Practice Address - Street 1:481 PENBROOKE DR
Practice Address - Street 2:SUITE 6
Practice Address - City:PENFIELD
Practice Address - State:NY
Practice Address - Zip Code:14526-2044
Practice Address - Country:US
Practice Address - Phone:585-388-1110
Practice Address - Fax:585-388-1124
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2010-05-07
Last Update Date:2010-05-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY012175-1261QP2000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QP2000XAmbulatory Health Care FacilitiesClinic/CenterPhysical Therapy