Provider Demographics
NPI:1679197784
Name:GOODWIN, MORGAN E (DPT)
Entity Type:Individual
Prefix:
First Name:MORGAN
Middle Name:E
Last Name:GOODWIN
Suffix:
Gender:F
Credentials:DPT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:5000 BENTON RD STE 1
Mailing Address - Street 2:
Mailing Address - City:BOSSIER CITY
Mailing Address - State:LA
Mailing Address - Zip Code:71111-6275
Mailing Address - Country:US
Mailing Address - Phone:318-584-7025
Mailing Address - Fax:318-703-6885
Practice Address - Street 1:5000 BENTON RD STE 1
Practice Address - Street 2:
Practice Address - City:BOSSIER CITY
Practice Address - State:LA
Practice Address - Zip Code:71111-6275
Practice Address - Country:US
Practice Address - Phone:318-584-7025
Practice Address - Fax:318-703-6885
Is Sole Proprietor?:No
Enumeration Date:2020-06-04
Last Update Date:2021-07-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
2251X0800X
LA106072251X0800X, 2251G0304X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2251X0800XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical TherapistOrthopedic
No2251G0304XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical TherapistGeriatrics
Provider Identifiers
StateIdentifier IDID TypeIssuer
LA10607OtherLOUISIANA STATE BOARD OF PHYSICAL THERAPY