Provider Demographics
NPI:1598072480
Name:GOODMAN, CRYSTAL MILLER (PT)
Entity Type:Individual
Prefix:
First Name:CRYSTAL
Middle Name:MILLER
Last Name:GOODMAN
Suffix:
Gender:F
Credentials:PT
Other - Prefix:
Other - First Name:CRYSTAL
Other - Middle Name:NOEL
Other - Last Name:MILLER
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:1525 COUNTRY CLUB RD
Mailing Address - Street 2:ATTN: PHYSICAL THERAPY DEPARTMENT
Mailing Address - City:SHERWOOD
Mailing Address - State:AR
Mailing Address - Zip Code:72120-5076
Mailing Address - Country:US
Mailing Address - Phone:501-978-3135
Mailing Address - Fax:
Practice Address - Street 1:1525 COUNTRY CLUB RD
Practice Address - Street 2:ATTN: PHYSICAL THERAPY DEPARTMENT
Practice Address - City:SHERWOOD
Practice Address - State:AR
Practice Address - Zip Code:72120-5076
Practice Address - Country:US
Practice Address - Phone:501-978-3135
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2010-09-13
Last Update Date:2010-09-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AR3272225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist