Provider Demographics
NPI:1326037946
Name:GOODE, ANTHONY TIO (PHYSICAL THERAPIST)
Entity type:Individual
Prefix:MR
First Name:ANTHONY
Middle Name:TIO
Last Name:GOODE
Suffix:
Gender:M
Credentials:PHYSICAL THERAPIST
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:5815 S PARK AVE
Mailing Address - Street 2:
Mailing Address - City:HAMBURG
Mailing Address - State:NY
Mailing Address - Zip Code:14075-3738
Mailing Address - Country:US
Mailing Address - Phone:716-648-8700
Mailing Address - Fax:716-648-0400
Practice Address - Street 1:5815 S PARK AVE
Practice Address - Street 2:
Practice Address - City:HAMBURG
Practice Address - State:NY
Practice Address - Zip Code:14075-3738
Practice Address - Country:US
Practice Address - Phone:716-648-8700
Practice Address - Fax:716-648-0400
Is Sole Proprietor?:Not Answered
Enumeration Date:2005-10-17
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY24366-1225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY00027049701OtherUNIVERA PROV#
NY000626886003OtherBCBS PROV#
NY9390493OtherIHA PROV#
NY000626886003OtherBCBS PROV#