Provider Demographics
NPI:1568540912
Name:GOODE, JASON
Entity Type:Individual
Prefix:
First Name:JASON
Middle Name:
Last Name:GOODE
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2120 N MACARTHUR BLVD
Mailing Address - Street 2:SUITE 100
Mailing Address - City:IRVING
Mailing Address - State:TX
Mailing Address - Zip Code:75061-2221
Mailing Address - Country:US
Mailing Address - Phone:210-884-0662
Mailing Address - Fax:
Practice Address - Street 1:2120 N MACARTHUR BLVD
Practice Address - Street 2:SUITE 100
Practice Address - City:IRVING
Practice Address - State:TX
Practice Address - Zip Code:75061-2221
Practice Address - Country:US
Practice Address - Phone:210-884-0662
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2006-11-02
Last Update Date:2009-03-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX1171289OtherSTATE LICENSE NUMBER