Provider Demographics
NPI:1588734636
Name:GOODMAN, DEENA POLL (PT)
Entity type:Individual
Prefix:
First Name:DEENA
Middle Name:POLL
Last Name:GOODMAN
Suffix:
Gender:F
Credentials:PT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2001 S BARRINGTON AVE STE 119
Mailing Address - Street 2:
Mailing Address - City:LOS ANGELES
Mailing Address - State:CA
Mailing Address - Zip Code:90025-5337
Mailing Address - Country:US
Mailing Address - Phone:310-441-1102
Mailing Address - Fax:310-441-1088
Practice Address - Street 1:2001 S BARRINGTON AVE STE 119
Practice Address - Street 2:
Practice Address - City:LOS ANGELES
Practice Address - State:CA
Practice Address - Zip Code:90025-5337
Practice Address - Country:US
Practice Address - Phone:310-441-1102
Practice Address - Fax:310-441-1088
Is Sole Proprietor?:Yes
Enumeration Date:2006-11-08
Last Update Date:2020-05-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAPT 184372251X0800X, 225100000X, 2251G0304X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist
No2251X0800XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical TherapistOrthopedic
No2251G0304XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical TherapistGeriatrics
Provider Identifiers
StateIdentifier IDID TypeIssuer
CA721606721OtherTIN
CA721606721OtherTIN