Provider Demographics
NPI:1528262847
Name:GOODWILL, MATTHEW J (PT)
Entity type:Individual
Prefix:
First Name:MATTHEW
Middle Name:J
Last Name:GOODWILL
Suffix:
Gender:M
Credentials:PT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:8099 CORNELL RD
Mailing Address - Street 2:
Mailing Address - City:CINCINNATI
Mailing Address - State:OH
Mailing Address - Zip Code:45249-2231
Mailing Address - Country:US
Mailing Address - Phone:513-793-3933
Mailing Address - Fax:513-985-2242
Practice Address - Street 1:8099 CORNELL RD
Practice Address - Street 2:
Practice Address - City:CINCINNATI
Practice Address - State:OH
Practice Address - Zip Code:45249-2231
Practice Address - Country:US
Practice Address - Phone:513-793-3933
Practice Address - Fax:513-985-2242
Is Sole Proprietor?:No
Enumeration Date:2007-06-12
Last Update Date:2009-04-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OHPT 011772225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist
Provider Identifiers
StateIdentifier IDID TypeIssuer
OHP00622900OtherMEDICARE RAILROAD