Basic Information
| Provider Information | |||||||||
| NPI: | 1629643275 | ||||||||
| EntityType: | 1 | ||||||||
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| OrganizationName: | |||||||||
| LastName: | GOODMAN | ||||||||
| FirstName: | JORDAN | ||||||||
| MiddleName: | PAIGE | ||||||||
| NamePrefix: | MS. | ||||||||
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| Credential: | CRT, RRT | ||||||||
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| Mailing Information | |||||||||
| Address1: | 514 MOUNT PLEASANT RD | ||||||||
| Address2: | |||||||||
| City: | WHITEVILLE | ||||||||
| State: | TN | ||||||||
| PostalCode: | 380756243 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 7312342225 | ||||||||
| FaxNumber: | |||||||||
| Practice Location | |||||||||
| Address1: | 5579 S ORANGE AVE | ||||||||
| Address2: | |||||||||
| City: | EDGEWOOD | ||||||||
| State: | FL | ||||||||
| PostalCode: | 328093493 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 4072414800 | ||||||||
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| Other Information | |||||||||
| ProviderEnumerationDate: | 05/26/2021 | ||||||||
| LastUpdateDate: | 05/26/2021 | ||||||||
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| ProviderGenderCode: | F | ||||||||
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| IsSoleProprietor: | N | ||||||||
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| NPICertificationDate: | 05/25/2021 | ||||||||
Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 227900000X | 179609 | TN | Y | Respiratory, Developmental, Rehabilitative and Restorative Service Providers | Respiratory Therapist, Registered |
No ID Information.