Provider Demographics
NPI:1629197298
Name:GOODMAN, JOHN PAUL (LMT)
Entity Type:Individual
Prefix:
First Name:JOHN
Middle Name:PAUL
Last Name:GOODMAN
Suffix:
Gender:M
Credentials:LMT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4350 WAKING SKY
Mailing Address - Street 2:
Mailing Address - City:SANTA FE
Mailing Address - State:NM
Mailing Address - Zip Code:87507-2573
Mailing Address - Country:US
Mailing Address - Phone:505-988-4439
Mailing Address - Fax:
Practice Address - Street 1:4350 WAKING SKY
Practice Address - Street 2:
Practice Address - City:SANTA FE
Practice Address - State:NM
Practice Address - Zip Code:87507-2573
Practice Address - Country:US
Practice Address - Phone:505-988-4439
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2007-03-28
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NM2961225700000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225700000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersMassage Therapist