Provider Demographics
NPI:1700982253
Name:GOODWIN, DONNA (MS, PT, MOMT)
Entity Type:Individual
Prefix:
First Name:DONNA
Middle Name:
Last Name:GOODWIN
Suffix:
Gender:F
Credentials:MS, PT, MOMT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1770 INDEPENDENCE CT
Mailing Address - Street 2:SUITE A
Mailing Address - City:BIRMINGHAM
Mailing Address - State:AL
Mailing Address - Zip Code:35216-1259
Mailing Address - Country:US
Mailing Address - Phone:205-871-4914
Mailing Address - Fax:205-871-6516
Practice Address - Street 1:1770 INDEPENDENCE CT
Practice Address - Street 2:SUITE A
Practice Address - City:BIRMINGHAM
Practice Address - State:AL
Practice Address - Zip Code:35216-1259
Practice Address - Country:US
Practice Address - Phone:205-871-4914
Practice Address - Fax:205-871-6516
Is Sole Proprietor?:No
Enumeration Date:2006-09-15
Last Update Date:2020-05-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
ALPTH2304225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist
Provider Identifiers
StateIdentifier IDID TypeIssuer
ALP53298Medicare UPIN
AL051505880Medicare ID - Type Unspecified