Provider Demographics
NPI:1598224099
Name:GOODWIN, MONICA PATRICE (DPT)
Entity Type:Individual
Prefix:
First Name:MONICA
Middle Name:PATRICE
Last Name:GOODWIN
Suffix:
Gender:F
Credentials:DPT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:41 ROSEANGEL CT
Mailing Address - Street 2:
Mailing Address - City:COLUMBIA
Mailing Address - State:SC
Mailing Address - Zip Code:29229-7198
Mailing Address - Country:US
Mailing Address - Phone:803-447-5138
Mailing Address - Fax:
Practice Address - Street 1:385 SPEARS CREEK CHURCH RD
Practice Address - Street 2:
Practice Address - City:ELGIN
Practice Address - State:SC
Practice Address - Zip Code:29045-8446
Practice Address - Country:US
Practice Address - Phone:803-828-7370
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2019-03-14
Last Update Date:2019-03-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
SC6951225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist