Provider Demographics
NPI:1740664721
Name:GOODMAN, JENNIFER (PT)
Entity type:Individual
Prefix:MRS
First Name:JENNIFER
Middle Name:
Last Name:GOODMAN
Suffix:
Gender:F
Credentials:PT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:10 HARDWOOD CT
Mailing Address - Street 2:
Mailing Address - City:AIKEN
Mailing Address - State:SC
Mailing Address - Zip Code:29803-7912
Mailing Address - Country:US
Mailing Address - Phone:803-642-4327
Mailing Address - Fax:
Practice Address - Street 1:123 DUPONT DR NW
Practice Address - Street 2:
Practice Address - City:AIKEN
Practice Address - State:SC
Practice Address - Zip Code:29801-4089
Practice Address - Country:US
Practice Address - Phone:803-648-0434
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2015-07-19
Last Update Date:2015-07-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
SC3709225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist