Basic Information
| Provider Information | |||||||||
| NPI: | 1750813804 | ||||||||
| EntityType: | 1 | ||||||||
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| OrganizationName: | |||||||||
| LastName: | GOOD | ||||||||
| FirstName: | JOSHUA | ||||||||
| MiddleName: | MARTIN | ||||||||
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| Credential: | PTA | ||||||||
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| Mailing Information | |||||||||
| Address1: | 4289 EVERETT AVE | ||||||||
| Address2: | |||||||||
| City: | SPRING HILL | ||||||||
| State: | FL | ||||||||
| PostalCode: | 346092206 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 3524427255 | ||||||||
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| Practice Location | |||||||||
| Address1: | 3363 W. WATERS AVENUE, SUITE 700 | ||||||||
| Address2: | |||||||||
| City: | TAMPA | ||||||||
| State: | FL | ||||||||
| PostalCode: | 33614 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 8139325119 | ||||||||
| FaxNumber: | 8139325539 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 03/29/2017 | ||||||||
| LastUpdateDate: | 03/29/2017 | ||||||||
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| ProviderGenderCode: | M | ||||||||
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| IsSoleProprietor: | Y | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 225200000X | PTA27293 | FL | Y | Respiratory, Developmental, Rehabilitative and Restorative Service Providers | Physical Therapy Assistant |
No ID Information.