Provider Demographics
NPI:1902205537
Name:GOODE, KATHLEEN (DPT)
Entity Type:Individual
Prefix:
First Name:KATHLEEN
Middle Name:
Last Name:GOODE
Suffix:
Gender:F
Credentials:DPT
Other - Prefix:
Other - First Name:KATIE
Other - Middle Name:
Other - Last Name:GOODE
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:DPT
Mailing Address - Street 1:210 COMMERCE WAY
Mailing Address - Street 2:
Mailing Address - City:PORTSMOUTH
Mailing Address - State:NH
Mailing Address - Zip Code:03801-8200
Mailing Address - Country:US
Mailing Address - Phone:603-427-8066
Mailing Address - Fax:603-501-0495
Practice Address - Street 1:84 HIGHLAND AVE
Practice Address - Street 2:201
Practice Address - City:SALEM
Practice Address - State:MA
Practice Address - Zip Code:01970-2727
Practice Address - Country:US
Practice Address - Phone:978-741-0880
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2014-08-20
Last Update Date:2015-02-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MA21240225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist