Provider Demographics
NPI:1821069543
Name:GOODEN, MARCIA IONI (PT)
Entity Type:Individual
Prefix:MS
First Name:MARCIA
Middle Name:IONI
Last Name:GOODEN
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 1:17081 MIRAMAR PKWY
Mailing Address - Street 2:#373
Mailing Address - City:MIRAMAR
Mailing Address - State:FL
Mailing Address - Zip Code:33027-4564
Mailing Address - Country:US
Mailing Address - Phone:305-467-7249
Mailing Address - Fax:954-447-9742
Practice Address - Street 1:501 GOLDEN ISLES DR
Practice Address - Street 2:SUITE 204 A-3
Practice Address - City:HALLANDALE BEACH
Practice Address - State:FL
Practice Address - Zip Code:33009-4729
Practice Address - Country:US
Practice Address - Phone:305-467-7249
Practice Address - Fax:
Is Sole Proprietor?:Not Answered
Enumeration Date:2006-01-30
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FL5616225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist
Provider Identifiers
StateIdentifier IDID TypeIssuer
FLY081DOtherBLUECROSS/BLUESHEILD
FLK7631Medicare ID - Type Unspecified