Provider Demographics
NPI:1588960645
Name:SANDRIDGE GOOD, JASMIN E (DPT)
Entity type:Individual
Prefix:
First Name:JASMIN
Middle Name:E
Last Name:SANDRIDGE GOOD
Suffix:
Gender:F
Credentials:DPT
Other - Prefix:
Other - First Name:JASMIN
Other - Middle Name:
Other - Last Name:GOOD
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:PT, DPT
Mailing Address - Street 1:2004 MAX LUTHER DR NW
Mailing Address - Street 2:
Mailing Address - City:HUNTSVILLE
Mailing Address - State:AL
Mailing Address - Zip Code:35810-3800
Mailing Address - Country:US
Mailing Address - Phone:256-852-9290
Mailing Address - Fax:256-852-1141
Practice Address - Street 1:2004 MAX LUTHER DR NW
Practice Address - Street 2:
Practice Address - City:HUNTSVILLE
Practice Address - State:AL
Practice Address - Zip Code:35810-3800
Practice Address - Country:US
Practice Address - Phone:256-852-9290
Practice Address - Fax:256-852-1141
Is Sole Proprietor?:No
Enumeration Date:2011-02-07
Last Update Date:2011-10-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
ALPTH225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist