Provider Demographics
NPI:1447303292
Name:GOODALE, AMANDA (PT)
Entity type:Individual
Prefix:
First Name:AMANDA
Middle Name:
Last Name:GOODALE
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 1:20 EAST ST
Mailing Address - Street 2:ANDERSON PHYSICAL THERAPY
Mailing Address - City:HANOVER
Mailing Address - State:MA
Mailing Address - Zip Code:02339-1638
Mailing Address - Country:US
Mailing Address - Phone:781-826-8309
Mailing Address - Fax:781-826-3610
Practice Address - Street 1:20 EAST ST
Practice Address - Street 2:ANDERSON PHYSICAL THERAPY
Practice Address - City:HANOVER
Practice Address - State:MA
Practice Address - Zip Code:02339-1638
Practice Address - Country:US
Practice Address - Phone:781-826-8309
Practice Address - Fax:781-826-3610
Is Sole Proprietor?:No
Enumeration Date:2007-01-18
Last Update Date:2020-01-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MA15057225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist
Provider Identifiers
StateIdentifier IDID TypeIssuer
MAY68613Medicare ID - Type Unspecified