Provider Demographics
NPI:1396546131
Name:GOODRUM, HELEN (ROLFER, BCTMB)
Entity type:Individual
Prefix:
First Name:HELEN
Middle Name:
Last Name:GOODRUM
Suffix:
Gender:F
Credentials:ROLFER, BCTMB
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:209 JACOB LN
Mailing Address - Street 2:
Mailing Address - City:PRESCOTT
Mailing Address - State:AZ
Mailing Address - Zip Code:86303-8805
Mailing Address - Country:US
Mailing Address - Phone:510-543-4994
Mailing Address - Fax:
Practice Address - Street 1:143 N MCCORMICK ST STE 101
Practice Address - Street 2:
Practice Address - City:PRESCOTT
Practice Address - State:AZ
Practice Address - Zip Code:86301-2725
Practice Address - Country:US
Practice Address - Phone:510-543-4994
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2025-03-19
Last Update Date:2025-03-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AZMT-28434225700000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225700000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersMassage Therapist