Provider Demographics
NPI:1831144385
Name:GOODMAN, JANN W (PT)
Entity Type:Individual
Prefix:MRS
First Name:JANN
Middle Name:W
Last Name:GOODMAN
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 1:7746 E BOSTON ST
Mailing Address - Street 2:
Mailing Address - City:MESA
Mailing Address - State:AZ
Mailing Address - Zip Code:85207
Mailing Address - Country:US
Mailing Address - Phone:480-380-2810
Mailing Address - Fax:480-380-2861
Practice Address - Street 1:844 N. ELLSWORTH
Practice Address - Street 2:
Practice Address - City:MESA
Practice Address - State:AZ
Practice Address - Zip Code:85207-5114
Practice Address - Country:US
Practice Address - Phone:480-380-2810
Practice Address - Fax:480-380-2861
Is Sole Proprietor?:No
Enumeration Date:2006-05-23
Last Update Date:2012-02-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AZ5005225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist
Provider Identifiers
StateIdentifier IDID TypeIssuer
AZAZ0298870OtherBCBS NUMBER
AZ755308Medicaid
AZ755308Medicaid