Provider Demographics
NPI:1689828592
Name:GOODE, DEANNA LINDSLEY (PT)
Entity Type:Individual
Prefix:
First Name:DEANNA
Middle Name:LINDSLEY
Last Name:GOODE
Suffix:
Gender:F
Credentials:PT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:5437 FM 3227
Mailing Address - Street 2:
Mailing Address - City:CANTON
Mailing Address - State:TX
Mailing Address - Zip Code:75103
Mailing Address - Country:US
Mailing Address - Phone:903-848-8033
Mailing Address - Fax:
Practice Address - Street 1:921 W DALLAS ST
Practice Address - Street 2:
Practice Address - City:CANTON
Practice Address - State:TX
Practice Address - Zip Code:75103-1009
Practice Address - Country:US
Practice Address - Phone:903-567-5579
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2008-11-06
Last Update Date:2008-11-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX1086411225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX00607YMedicare PIN