Provider Demographics
NPI:1992982458
Name:GOODWIN, DEBORAH D (PT)
Entity type:Individual
Prefix:
First Name:DEBORAH
Middle Name:D
Last Name:GOODWIN
Suffix:
Gender:F
Credentials:PT
Other - Prefix:
Other - First Name:DEBORAH
Other - Middle Name:D
Other - Last Name:NELSON
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:PT
Mailing Address - Street 1:710 HOSPITAL DRIVE
Mailing Address - Street 2:
Mailing Address - City:CRESTVIEW
Mailing Address - State:FL
Mailing Address - Zip Code:32539
Mailing Address - Country:US
Mailing Address - Phone:850-398-8480
Mailing Address - Fax:850-398-8482
Practice Address - Street 1:710 HOSPITAL DRIVE
Practice Address - Street 2:
Practice Address - City:CRESTVIEW
Practice Address - State:FL
Practice Address - Zip Code:32539
Practice Address - Country:US
Practice Address - Phone:850-398-8480
Practice Address - Fax:850-398-8482
Is Sole Proprietor?:No
Enumeration Date:2008-01-28
Last Update Date:2008-01-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLPT6063225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist