Provider Demographics
NPI:1750484978
Name:GOODWIN, CHRISTOPHER MATTHEW (PT)
Entity Type:Individual
Prefix:MR
First Name:CHRISTOPHER
Middle Name:MATTHEW
Last Name:GOODWIN
Suffix:
Gender:M
Credentials:PT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:12952 BANDERA RD
Mailing Address - Street 2:SUITE 107
Mailing Address - City:HELOTES
Mailing Address - State:TX
Mailing Address - Zip Code:78023-4689
Mailing Address - Country:US
Mailing Address - Phone:210-372-9600
Mailing Address - Fax:210-372-0211
Practice Address - Street 1:12952 BANDERA RD
Practice Address - Street 2:SUITE 107
Practice Address - City:HELOTES
Practice Address - State:TX
Practice Address - Zip Code:78023-4689
Practice Address - Country:US
Practice Address - Phone:210-372-9600
Practice Address - Fax:210-372-0211
Is Sole Proprietor?:No
Enumeration Date:2006-09-06
Last Update Date:2011-04-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX1079754225100000X, 2251S0007X, 2251X0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist
No2251S0007XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical TherapistSports
No2251X0800XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical TherapistOrthopedic
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX8T4082OtherBCBS INDIVIDUAL
TX8F0797Medicare ID - Type UnspecifiedINDIVIDUAL PROVIDER NUM
TXP00315889Medicare ID - Type UnspecifiedRAILROAD MC INDIVIDUAL