Provider Demographics
NPI:1649495409
Name:GOODNOUGH, CHRISTINA M (MSPT)
Entity type:Individual
Prefix:
First Name:CHRISTINA
Middle Name:M
Last Name:GOODNOUGH
Suffix:
Gender:F
Credentials:MSPT
Other - Prefix:
Other - First Name:CHRISTINA
Other - Middle Name:M
Other - Last Name:GRAVES
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:MSPT
Mailing Address - Street 1:3414 OLANDWOOD CT
Mailing Address - Street 2:
Mailing Address - City:OLNEY
Mailing Address - State:MD
Mailing Address - Zip Code:20832-1384
Mailing Address - Country:US
Mailing Address - Phone:301-774-0624
Mailing Address - Fax:301-774-4545
Practice Address - Street 1:3414 OLANDWOOD CT
Practice Address - Street 2:
Practice Address - City:OLNEY
Practice Address - State:MD
Practice Address - Zip Code:20832-1384
Practice Address - Country:US
Practice Address - Phone:301-774-0624
Practice Address - Fax:301-774-4545
Is Sole Proprietor?:No
Enumeration Date:2007-04-16
Last Update Date:2009-05-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MD222882251X0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2251X0800XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical TherapistOrthopedic
Provider Identifiers
StateIdentifier IDID TypeIssuer
MD715MMedicare PIN