Provider Demographics
NPI:1780612002
Name:FOX GOODE, KATHLEEN MARY (PT)
Entity type:Individual
Prefix:MRS
First Name:KATHLEEN
Middle Name:MARY
Last Name:FOX GOODE
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 1:12 E 46TH ST # 8FL
Mailing Address - Street 2:
Mailing Address - City:NEW YORK
Mailing Address - State:NY
Mailing Address - Zip Code:10017-2418
Mailing Address - Country:US
Mailing Address - Phone:212-499-0876
Mailing Address - Fax:212-953-1353
Practice Address - Street 1:12 E 46TH ST FL 8
Practice Address - Street 2:SUITE 2
Practice Address - City:NEW YORK
Practice Address - State:NY
Practice Address - Zip Code:10017-2418
Practice Address - Country:US
Practice Address - Phone:212-499-0848
Practice Address - Fax:212-499-0753
Is Sole Proprietor?:No
Enumeration Date:2006-06-28
Last Update Date:2014-10-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY020800-1225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist
Provider Identifiers
StateIdentifier IDID TypeIssuer
NYP3185498OtherOXFORD
NY1779725OtherUNITED HEALTHCARE
NYN46882OtherHEALTH NET
NYP3185498OtherOXFORD