Provider Demographics
NPI:1306604327
Name:GOODRICH PERFORMANCE THERAPY
Entity type:Organization
Organization Name:GOODRICH PERFORMANCE THERAPY
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER/PHYSICAL THERAPIST
Authorized Official - Prefix:
Authorized Official - First Name:DANIEL
Authorized Official - Middle Name:
Authorized Official - Last Name:GOODRICH
Authorized Official - Suffix:
Authorized Official - Credentials:DPT
Authorized Official - Phone:801-845-9950
Mailing Address - Street 1:PO BOX 313
Mailing Address - Street 2:
Mailing Address - City:MORGAN
Mailing Address - State:UT
Mailing Address - Zip Code:84050-0313
Mailing Address - Country:US
Mailing Address - Phone:801-845-9950
Mailing Address - Fax:801-845-9951
Practice Address - Street 1:209 N STATE ST STE D
Practice Address - Street 2:
Practice Address - City:MORGAN
Practice Address - State:UT
Practice Address - Zip Code:84050-9903
Practice Address - Country:US
Practice Address - Phone:801-845-9950
Practice Address - Fax:801-845-9951
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2024-03-13
Last Update Date:2024-03-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical TherapistGroup - Single Specialty