Provider Demographics
NPI:1689441081
Name:GOODWIN PELVIC PT PLLC
Entity Type:Organization
Organization Name:GOODWIN PELVIC PT PLLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER/ SINGLE-MEMBER
Authorized Official - Prefix:
Authorized Official - First Name:STEPHANIE
Authorized Official - Middle Name:ELISE
Authorized Official - Last Name:GOODWIN
Authorized Official - Suffix:
Authorized Official - Credentials:PT, DPT, PRPC
Authorized Official - Phone:774-232-3265
Mailing Address - Street 1:185 S BUCKHOUT ST
Mailing Address - Street 2:
Mailing Address - City:IRVINGTON
Mailing Address - State:NY
Mailing Address - Zip Code:10533
Mailing Address - Country:US
Mailing Address - Phone:774-232-3265
Mailing Address - Fax:
Practice Address - Street 1:185 S BUCKHOUT ST
Practice Address - Street 2:
Practice Address - City:IRVINGTON
Practice Address - State:NY
Practice Address - Zip Code:10533
Practice Address - Country:US
Practice Address - Phone:774-232-3265
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2023-12-06
Last Update Date:2023-12-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical TherapistGroup - Single Specialty