1871663310 NPI number — GODDARD ORTHOPEDIC AND SPORTS THERAPY INC

Table of content: (NPI 1871663310)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1871663310 NPI number — GODDARD ORTHOPEDIC AND SPORTS THERAPY INC

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
GODDARD ORTHOPEDIC AND SPORTS THERAPY INC
Provider Last Name:
Provider First Name:
Provider Middle Name:
Provider Name Prefix Text:
Provider Name Suffix Text:
Provider Credential Text:
Provider Gender Code:

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
Provider Other Last Name:
Provider Other First Name:
Provider Other Middle Name:
Provider Other Name Prefix Text:
Provider Other Name Suffix Text:
Provider Other Credential Text:
Provider Other Last Name Type Code:

NPI Number Information

NPI Number:
1871663310
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
08/22/2020
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
1199 S BELT LINE RD
Provider Second Line Business Mailing Address:
SUITE 140
Provider Business Mailing Address City Name:
COPPELL
Provider Business Mailing Address State Name:
TX
Provider Business Mailing Address Postal Code:
75019-4666
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
972-745-9060
Provider Business Mailing Address Fax Number:
972-745-9069

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
1199 S BELT LINE RD
Provider Second Line Business Practice Location Address:
SUITE 140
Provider Business Practice Location Address City Name:
COPPELL
Provider Business Practice Location Address State Name:
TX
Provider Business Practice Location Address Postal Code:
75019-4666
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
972-745-9060
Provider Business Practice Location Address Fax Number:
972-745-9069
Provider Enumeration Date:
11/09/2006

Additional Information

Authorized Official

Authorized Official Last Name:
GODDARD
Authorized Official First Name:
AMY
Authorized Official Middle Name:
LOUISE
Authorized Official Title or Position:
PRESIDENT
Authorized Official Telephone Number:
972-745-9060

Provider Taxonomy Codes

  • Taxonomy code: 225100000X , with the licence number:  1101657 , registered in the state of TX ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

Other Provider's Identifiers (legacy, non-NPI)





Copyright © 2007-2025 www.npivalidator.com