Provider Demographics
NPI:1710106018
Name:GOODWILL, CHRISTINA LYNN (MSPT)
Entity Type:Individual
Prefix:
First Name:CHRISTINA
Middle Name:LYNN
Last Name:GOODWILL
Suffix:
Gender:F
Credentials:MSPT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:5331 SW MACADAM AVE
Mailing Address - Street 2:SUITE 105
Mailing Address - City:PORTLAND
Mailing Address - State:OR
Mailing Address - Zip Code:97239-6104
Mailing Address - Country:US
Mailing Address - Phone:503-445-7999
Mailing Address - Fax:503-445-7997
Practice Address - Street 1:5331 SW MACADAM AVE
Practice Address - Street 2:SUITE 105
Practice Address - City:PORTLAND
Practice Address - State:OR
Practice Address - Zip Code:97239-6104
Practice Address - Country:US
Practice Address - Phone:503-445-7999
Practice Address - Fax:503-445-7997
Is Sole Proprietor?:No
Enumeration Date:2007-04-25
Last Update Date:2012-12-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OR3758225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist