Provider Demographics
NPI:1790927226
Name:GOODMAN FROHLICH, MICHELLE J (DPT)
Entity Type:Individual
Prefix:DR
First Name:MICHELLE
Middle Name:J
Last Name:GOODMAN FROHLICH
Suffix:
Gender:F
Credentials:DPT
Other - Prefix:DR
Other - First Name:MICHELLE
Other - Middle Name:J
Other - Last Name:GOODMAN
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:DPT
Mailing Address - Street 1:485 HAROLD ST
Mailing Address - Street 2:
Mailing Address - City:STATEN ISLAND
Mailing Address - State:NY
Mailing Address - Zip Code:10314-5017
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:485 HAROLD ST
Practice Address - Street 2:
Practice Address - City:STATEN ISLAND
Practice Address - State:NY
Practice Address - Zip Code:10314-5017
Practice Address - Country:US
Practice Address - Phone:718-982-5648
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2009-03-30
Last Update Date:2009-03-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY030021225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist