Active NPI
Nancy Ann Goodell
- Physical Therapist
- Port Huron, MI
National Provider Identifier
1003387150
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Physical Therapist
- License
- 5501001361
- Practice address
- 1411 3Rd St Ste 3
Port Huron, MI 48060-5480 - Phone
- (586) 323-6290
- NPI assigned
- Dec 16, 2018
- Sex
- Female
- Sole proprietor
- No
NPPES NPI Registry
Registry information is reported by the provider to CMS and is not verified. About this source
Specialties & licenses 1
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Physical Therapist | 225100000X | 5501001361 | MI | Primary |
Addresses
Primary practice location
1411 3Rd St Ste 3
Port Huron, MI 48060-5480
Mailing address
15521 Stockton Dr
Clinton Township, MI 48038-2673
Phone (586) 228-7125
Medicare participation
Medicare enrollment files- Medicare fee-for-service enrollment
- Not listed in the public Medicare enrollment file
National Provider Directory
National Provider Directory- Medicare enrollment (NPD)
- Not enrolled
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| 5501001361 | MI | MD | Physical Therapist |
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1544918400000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1544918400000",
"number": "1003387150",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "15521 STOCKTON DR",
"city": "CLINTON TOWNSHIP",
"state": "MI",
"postal_code": "480382673",
"telephone_number": "586-228-7125"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "1411 3RD ST STE 3",
"city": "PORT HURON",
"state": "MI",
"postal_code": "480605480",
"telephone_number": "586-323-6290"
}
],
"practiceLocations": [],
"basic": {
"last_name": "GOODELL",
"first_name": "NANCY",
"middle_name": "ANN",
"sole_proprietor": "NO",
"sex": "F",
"enumeration_date": "2018-12-16",
"last_updated": "2018-12-16",
"status": "A"
},
"taxonomies": [
{
"code": "225100000X",
"taxonomy_group": "",
"desc": "Physical Therapist",
"state": "MI",
"license": "5501001361",
"primary": true
}
],
"identifiers": [],
"endpoints": [],
"other_names": []
}Other providers in Port Huron, MI
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Dec 16, 2018; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.