Provider Demographics
NPI:1093229023
Name:GOODWIN, KYLEE (DPT)
Entity type:Individual
Prefix:
First Name:KYLEE
Middle Name:
Last Name:GOODWIN
Suffix:
Gender:F
Credentials:DPT
Other - Prefix:
Other - First Name:KYLEE
Other - Middle Name:
Other - Last Name:BLAKE
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:DPT
Mailing Address - Street 1:PO BOX 306393
Mailing Address - Street 2:
Mailing Address - City:NASHVILLE
Mailing Address - State:TN
Mailing Address - Zip Code:37230-6393
Mailing Address - Country:US
Mailing Address - Phone:615-373-1350
Mailing Address - Fax:
Practice Address - Street 1:5285 HIGHWAY 280 STE 109
Practice Address - Street 2:
Practice Address - City:BIRMINGHAM
Practice Address - State:AL
Practice Address - Zip Code:35242-0317
Practice Address - Country:US
Practice Address - Phone:205-607-0903
Practice Address - Fax:205-607-0904
Is Sole Proprietor?:No
Enumeration Date:2017-11-29
Last Update Date:2021-12-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
225100000X
ALPTH8786225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist