Provider Demographics
NPI:1619223286
Name:GOODEN, JACQUELINE VIRGINIA (DPT)
Entity Type:Individual
Prefix:
First Name:JACQUELINE
Middle Name:VIRGINIA
Last Name:GOODEN
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 1:20347 TIMBERLAKE RD
Mailing Address - Street 2:STE B
Mailing Address - City:LYNCHBURG
Mailing Address - State:VA
Mailing Address - Zip Code:24502-7352
Mailing Address - Country:US
Mailing Address - Phone:434-845-9053
Mailing Address - Fax:434-528-2788
Practice Address - Street 1:20311 TIMBERLAKE RD
Practice Address - Street 2:STE B
Practice Address - City:LYNCHBURG
Practice Address - State:VA
Practice Address - Zip Code:24502-7203
Practice Address - Country:US
Practice Address - Phone:434-845-9053
Practice Address - Fax:434-528-2788
Is Sole Proprietor?:No
Enumeration Date:2012-08-01
Last Update Date:2016-11-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA2305207484225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist