Provider Demographics
NPI:1548781222
Name:GOODROE, ABIGAIL MARIE (AT, ATC)
Entity Type:Individual
Prefix:
First Name:ABIGAIL
Middle Name:MARIE
Last Name:GOODROE
Suffix:
Gender:F
Credentials:AT, ATC
Other - Prefix:
Other - First Name:ABIGAIL
Other - Middle Name:MARIE
Other - Last Name:GORHAM
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:AT, ATC
Mailing Address - Street 1:10860 HIGHLAND RD
Mailing Address - Street 2:
Mailing Address - City:HARTLAND
Mailing Address - State:MI
Mailing Address - Zip Code:48353-2629
Mailing Address - Country:US
Mailing Address - Phone:810-632-1000
Mailing Address - Fax:810-632-1001
Practice Address - Street 1:10860 HIGHLAND RD
Practice Address - Street 2:
Practice Address - City:HARTLAND
Practice Address - State:MI
Practice Address - Zip Code:48353-2629
Practice Address - Country:US
Practice Address - Phone:810-632-1000
Practice Address - Fax:810-632-1001
Is Sole Proprietor?:No
Enumeration Date:2017-07-03
Last Update Date:2021-02-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI26010015532255A2300X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2255A2300XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersSpecialist/TechnologistAthletic Trainer