Provider Demographics
NPI:1891089579
Name:GOODBODY, JOHN PETER (PT)
Entity Type:Individual
Prefix:MR
First Name:JOHN
Middle Name:PETER
Last Name:GOODBODY
Suffix:
Gender:M
Credentials:PT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:8335 GRAVES PT.
Mailing Address - Street 2:
Mailing Address - City:WOLCOTT
Mailing Address - State:NY
Mailing Address - Zip Code:14590
Mailing Address - Country:US
Mailing Address - Phone:315-594-8580
Mailing Address - Fax:
Practice Address - Street 1:8335 GRAVES PT.
Practice Address - Street 2:
Practice Address - City:WOLCOTT
Practice Address - State:NY
Practice Address - Zip Code:14590
Practice Address - Country:US
Practice Address - Phone:315-594-8580
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2011-05-31
Last Update Date:2011-05-31
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY001568-1225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist