Provider Demographics
NPI:1023235660
Name:GOODE, JEFFREY DUANE (MPT)
Entity type:Individual
Prefix:MR
First Name:JEFFREY
Middle Name:DUANE
Last Name:GOODE
Suffix:
Gender:M
Credentials:MPT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:525 N ADA ST
Mailing Address - Street 2:#50
Mailing Address - City:CHICAGO
Mailing Address - State:IL
Mailing Address - Zip Code:60622-6485
Mailing Address - Country:US
Mailing Address - Phone:312-666-9968
Mailing Address - Fax:
Practice Address - Street 1:1455 S MICHIGAN AVE
Practice Address - Street 2:SUITE 230
Practice Address - City:CHICAGO
Practice Address - State:IL
Practice Address - Zip Code:60605-2771
Practice Address - Country:US
Practice Address - Phone:312-360-0702
Practice Address - Fax:312-360-0705
Is Sole Proprietor?:Yes
Enumeration Date:2007-04-18
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL070.007393174400000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes174400000XOther Service ProvidersSpecialist