Provider Demographics
NPI:1396156279
Name:GOODMAN, AMANDA LEIGH (DPT)
Entity type:Individual
Prefix:
First Name:AMANDA
Middle Name:LEIGH
Last Name:GOODMAN
Suffix:
Gender:F
Credentials:DPT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2823 GREYSTONE COMMERCIAL BLVD
Mailing Address - Street 2:
Mailing Address - City:HOOVER
Mailing Address - State:AL
Mailing Address - Zip Code:35242-2660
Mailing Address - Country:US
Mailing Address - Phone:205-745-3660
Mailing Address - Fax:205-745-3649
Practice Address - Street 1:2701 FREDERICK RD STE 306
Practice Address - Street 2:
Practice Address - City:OPELIKA
Practice Address - State:AL
Practice Address - Zip Code:36801-7281
Practice Address - Country:US
Practice Address - Phone:334-610-0354
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2014-05-14
Last Update Date:2021-08-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
ALPTH6821225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist