Active NPI
Tyler Belser Goodman
- Physical Therapist
- Niceville, FL
National Provider Identifier
1043821366
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Physical Therapist
- License
- 27614
- Practice address
- 4554 E Highway 20
Niceville, FL 32578-9755 - Phone
- (850) 897-7772
- NPI assigned
- Aug 11, 2020
- Sex
- Male
- Sole proprietor
- Yes
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 | 27614 | FL | Primary |
Addresses
Primary practice location
4554 E Highway 20
Niceville, FL 32578-9755
Mailing address
PO Box 1772
Crestview, FL 32536-7772
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)
- Enrolled
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| 27614 | FL | MD | Physical Therapist |
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1597104000000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1597104000000",
"number": "1043821366",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "PO BOX 1772",
"city": "CRESTVIEW",
"state": "FL",
"postal_code": "325367772"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "4554 E HIGHWAY 20",
"city": "NICEVILLE",
"state": "FL",
"postal_code": "325789755",
"telephone_number": "850-897-7772"
}
],
"practiceLocations": [],
"basic": {
"last_name": "GOODMAN",
"first_name": "TYLER",
"middle_name": "BELSER",
"sole_proprietor": "YES",
"sex": "M",
"enumeration_date": "2020-08-11",
"last_updated": "2020-08-11",
"certification_date": "2020-08-11",
"status": "A"
},
"taxonomies": [
{
"code": "225100000X",
"taxonomy_group": "193400000X SINGLE SPECIALTY GROUP",
"desc": "Physical Therapist",
"state": "FL",
"license": "27614",
"primary": true
}
],
"identifiers": [],
"endpoints": [],
"other_names": []
}Other providers in Niceville, FL
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Aug 11, 2020; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.