Provider Demographics
NPI:1083689467
Name:GOODMAN-O'ROURKE, ALLISON (MSPT)
Entity type:Individual
Prefix:
First Name:ALLISON
Middle Name:
Last Name:GOODMAN-O'ROURKE
Suffix:
Gender:F
Credentials:MSPT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:180 MAIN ST
Mailing Address - Street 2:
Mailing Address - City:BRIDGEWATER
Mailing Address - State:MA
Mailing Address - Zip Code:02324-1452
Mailing Address - Country:US
Mailing Address - Phone:508-697-8934
Mailing Address - Fax:
Practice Address - Street 1:150 EMORY ST
Practice Address - Street 2:
Practice Address - City:ATTLEBORO
Practice Address - State:MA
Practice Address - Zip Code:02703-2439
Practice Address - Country:US
Practice Address - Phone:508-222-5800
Practice Address - Fax:508-222-6170
Is Sole Proprietor?:Not Answered
Enumeration Date:2006-02-21
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MA10313225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist