Provider Demographics
NPI:1619721917
Name:GOODWIN, ADAM ANTHONY (PT, DPT)
Entity Type:Individual
Prefix:DR
First Name:ADAM
Middle Name:ANTHONY
Last Name:GOODWIN
Suffix:
Gender:M
Credentials:PT, DPT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:7768 LIALANA WAY
Mailing Address - Street 2:
Mailing Address - City:CITRUS HEIGHTS
Mailing Address - State:CA
Mailing Address - Zip Code:95610-5023
Mailing Address - Country:US
Mailing Address - Phone:916-225-9732
Mailing Address - Fax:
Practice Address - Street 1:3110 WAGNER HEIGHTS RD
Practice Address - Street 2:
Practice Address - City:STOCKTON
Practice Address - State:CA
Practice Address - Zip Code:95209-4848
Practice Address - Country:US
Practice Address - Phone:209-956-3444
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2024-04-15
Last Update Date:2024-04-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA305514225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist