Provider Demographics
NPI:1578757951
Name:GOODE, SUSAN E (MSPT)
Entity Type:Individual
Prefix:
First Name:SUSAN
Middle Name:E
Last Name:GOODE
Suffix:
Gender:F
Credentials:MSPT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:434 KELLY LYNN DR
Mailing Address - Street 2:
Mailing Address - City:ANNISTON
Mailing Address - State:AL
Mailing Address - Zip Code:36207-4804
Mailing Address - Country:US
Mailing Address - Phone:256-225-7702
Mailing Address - Fax:
Practice Address - Street 1:434 KELLY LYNN DR
Practice Address - Street 2:
Practice Address - City:ANNISTON
Practice Address - State:AL
Practice Address - Zip Code:36207-4804
Practice Address - Country:US
Practice Address - Phone:256-225-7702
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2007-08-29
Last Update Date:2007-08-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
ALPTH3347225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist