Provider Demographics
NPI:1457091282
Name:GOODYEAR, NIKOLAI (DPT)
Entity Type:Individual
Prefix:
First Name:NIKOLAI
Middle Name:
Last Name:GOODYEAR
Suffix:
Gender:M
Credentials:DPT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:14190 ORCHARD PKWY STE 250
Mailing Address - Street 2:
Mailing Address - City:WESTMINSTER
Mailing Address - State:CO
Mailing Address - Zip Code:80023-9708
Mailing Address - Country:US
Mailing Address - Phone:720-497-6666
Mailing Address - Fax:720-497-6777
Practice Address - Street 1:14190 ORCHARD PKWY STE 250
Practice Address - Street 2:
Practice Address - City:WESTMINSTER
Practice Address - State:CO
Practice Address - Zip Code:80023-9708
Practice Address - Country:US
Practice Address - Phone:720-497-6666
Practice Address - Fax:720-497-6777
Is Sole Proprietor?:No
Enumeration Date:2022-03-30
Last Update Date:2022-07-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
ARPT4804225100000X
NCP-CP011162T225100000X
COCP010362T225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist