Provider Demographics
NPI:1871663310
Name:GODDARD ORTHOPEDIC AND SPORTS THERAPY INC
Entity Type:Organization
Organization Name:GODDARD ORTHOPEDIC AND SPORTS THERAPY INC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:MS
Authorized Official - First Name:AMY
Authorized Official - Middle Name:LOUISE
Authorized Official - Last Name:GODDARD
Authorized Official - Suffix:
Authorized Official - Credentials:PT CSCS
Authorized Official - Phone:972-745-9060
Mailing Address - Street 1:1199 S BELT LINE RD
Mailing Address - Street 2:SUITE 140
Mailing Address - City:COPPELL
Mailing Address - State:TX
Mailing Address - Zip Code:75019-4666
Mailing Address - Country:US
Mailing Address - Phone:972-745-9060
Mailing Address - Fax:972-745-9069
Practice Address - Street 1:1199 S BELT LINE RD
Practice Address - Street 2:SUITE 140
Practice Address - City:COPPELL
Practice Address - State:TX
Practice Address - Zip Code:75019-4666
Practice Address - Country:US
Practice Address - Phone:972-745-9060
Practice Address - Fax:972-745-9069
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-11-09
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX1101657225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical TherapistGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX=========OtherTAX ID