Provider Demographics
NPI:1629192216
Name:GOODE, ANGELIA (PT)
Entity Type:Individual
Prefix:
First Name:ANGELIA
Middle Name:
Last Name:GOODE
Suffix:
Gender:F
Credentials:PT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:212 MOUNT JOY CHURCH RD
Mailing Address - Street 2:
Mailing Address - City:JONESVILLE
Mailing Address - State:SC
Mailing Address - Zip Code:29353-2905
Mailing Address - Country:US
Mailing Address - Phone:864-301-0995
Mailing Address - Fax:
Practice Address - Street 1:212 MOUNT JOY CHURCH RD
Practice Address - Street 2:
Practice Address - City:JONESVILLE
Practice Address - State:SC
Practice Address - Zip Code:29353
Practice Address - Country:US
Practice Address - Phone:864-301-0995
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2007-03-19
Last Update Date:2014-02-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA2305204129225100000X
NC4808225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist