Provider Demographics
NPI:1588845390
Name:GOODHEART, BRUCE (PT)
Entity Type:Individual
Prefix:
First Name:BRUCE
Middle Name:
Last Name:GOODHEART
Suffix:
Gender:M
Credentials:PT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:11 FRANKLIN PL
Mailing Address - Street 2:
Mailing Address - City:WOODMERE
Mailing Address - State:NY
Mailing Address - Zip Code:11598-1216
Mailing Address - Country:US
Mailing Address - Phone:516-569-0373
Mailing Address - Fax:516-569-0374
Practice Address - Street 1:11 FRANKLIN PL
Practice Address - Street 2:
Practice Address - City:WOODMERE
Practice Address - State:NY
Practice Address - Zip Code:11598-1216
Practice Address - Country:US
Practice Address - Phone:516-569-0373
Practice Address - Fax:516-569-0374
Is Sole Proprietor?:Yes
Enumeration Date:2007-11-20
Last Update Date:2019-11-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
013032225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist
Provider Identifiers
StateIdentifier IDID TypeIssuer
Q04S91Medicare UPIN