Provider Demographics
NPI:1457752651
Name:GOODSON, SHARON WATKINS (BS IN PT)
Entity Type:Individual
Prefix:MRS
First Name:SHARON
Middle Name:WATKINS
Last Name:GOODSON
Suffix:
Gender:F
Credentials:BS IN PT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
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Other - Credentials:
Mailing Address - Street 1:320 OLD SOUTH WAY
Mailing Address - Street 2:
Mailing Address - City:MOUNT PLEASANT
Mailing Address - State:SC
Mailing Address - Zip Code:29464-7855
Mailing Address - Country:US
Mailing Address - Phone:843-412-8554
Mailing Address - Fax:
Practice Address - Street 1:320 OLD SOUTH WAY
Practice Address - Street 2:
Practice Address - City:MOUNT PLEASANT
Practice Address - State:SC
Practice Address - Zip Code:29464-7855
Practice Address - Country:US
Practice Address - Phone:843-412-8554
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2014-09-08
Last Update Date:2014-09-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
SC1160225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist