Provider Demographics
NPI:1730448887
Name:GOODWIN, RYAN GEORGE (PT)
Entity type:Individual
Prefix:
First Name:RYAN
Middle Name:GEORGE
Last Name:GOODWIN
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 1:28530 RAVENS PRAIRIE DR
Mailing Address - Street 2:
Mailing Address - City:KATY
Mailing Address - State:TX
Mailing Address - Zip Code:77494-0677
Mailing Address - Country:US
Mailing Address - Phone:281-347-2141
Mailing Address - Fax:
Practice Address - Street 1:28530 RAVENS PRAIRIE DR
Practice Address - Street 2:
Practice Address - City:KATY
Practice Address - State:TX
Practice Address - Zip Code:77494-0677
Practice Address - Country:US
Practice Address - Phone:281-347-2141
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2012-05-10
Last Update Date:2012-05-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX11352832251X0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2251X0800XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical TherapistOrthopedic