Provider Demographics
NPI:1598956807
Name:GOODMAN, MELISSA LEW (DPT)
Entity Type:Individual
Prefix:
First Name:MELISSA
Middle Name:LEW
Last Name:GOODMAN
Suffix:
Gender:F
Credentials:DPT
Other - Prefix:
Other - First Name:MELISSA
Other - Middle Name:SUSAN
Other - Last Name:LEW
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:CANTRELL CENTER FOR PHYSICAL THERAPY & SPORTS MEDICINE
Mailing Address - Street 2:405 OSIGIAN BLVD
Mailing Address - City:WARNER ROBINS
Mailing Address - State:GA
Mailing Address - Zip Code:31088-8958
Mailing Address - Country:US
Mailing Address - Phone:478-953-3535
Mailing Address - Fax:478-953-0353
Practice Address - Street 1:CANTRELL CENTER FOR PHYSICAL THERAPY & SPORTS MEDICINE
Practice Address - Street 2:405 OSIGIAN BLVD
Practice Address - City:WARNER ROBINS
Practice Address - State:GA
Practice Address - Zip Code:31088-8958
Practice Address - Country:US
Practice Address - Phone:478-953-3535
Practice Address - Fax:478-953-0353
Is Sole Proprietor?:Yes
Enumeration Date:2007-08-05
Last Update Date:2007-08-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GA006861225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist