Provider Demographics
NPI:1780704064
Name:GOODE, JEFFREY HERBERT (PT)
Entity type:Individual
Prefix:
First Name:JEFFREY
Middle Name:HERBERT
Last Name:GOODE
Suffix:
Gender:M
Credentials:PT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2098 WOODHILL PL
Mailing Address - Street 2:
Mailing Address - City:SAINT ALBANS
Mailing Address - State:WV
Mailing Address - Zip Code:25177-3531
Mailing Address - Country:US
Mailing Address - Phone:304-727-7776
Mailing Address - Fax:304-388-7788
Practice Address - Street 1:2098 WOODHILL PL
Practice Address - Street 2:
Practice Address - City:SAINT ALBANS
Practice Address - State:WV
Practice Address - Zip Code:25177-3531
Practice Address - Country:US
Practice Address - Phone:304-727-7776
Practice Address - Fax:304-388-7788
Is Sole Proprietor?:Yes
Enumeration Date:2007-03-30
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WV1062225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist