Provider Demographics
NPI:1639737372
Name:GOODMAN, ELIZABETH GREY (PT, DPT)
Entity Type:Individual
Prefix:
First Name:ELIZABETH
Middle Name:GREY
Last Name:GOODMAN
Suffix:
Gender:F
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 1:111A SUNSET AVE
Mailing Address - Street 2:
Mailing Address - City:CAMDEN
Mailing Address - State:NC
Mailing Address - Zip Code:27921-9641
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:111A SUNSET AVE
Practice Address - Street 2:
Practice Address - City:CAMDEN
Practice Address - State:NC
Practice Address - Zip Code:27921-9641
Practice Address - Country:US
Practice Address - Phone:252-312-9719
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2019-05-29
Last Update Date:2019-05-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IN05013341A225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist