Provider Demographics
NPI:1629643275
Name:GOODMAN, JORDAN PAIGE (CRT, RRT)
Entity Type:Individual
Prefix:MS
First Name:JORDAN
Middle Name:PAIGE
Last Name:GOODMAN
Suffix:
Gender:F
Credentials:CRT, RRT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:514 MOUNT PLEASANT RD
Mailing Address - Street 2:
Mailing Address - City:WHITEVILLE
Mailing Address - State:TN
Mailing Address - Zip Code:38075-6243
Mailing Address - Country:US
Mailing Address - Phone:731-234-2225
Mailing Address - Fax:
Practice Address - Street 1:5579 S ORANGE AVE
Practice Address - Street 2:
Practice Address - City:EDGEWOOD
Practice Address - State:FL
Practice Address - Zip Code:32809-3493
Practice Address - Country:US
Practice Address - Phone:407-241-4800
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2021-05-26
Last Update Date:2021-05-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TN179609227900000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes227900000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersRespiratory Therapist, Registered