Active NPI
Kevin Todd Goodwill, PTA
- Physical Therapy Assistant
- Columbia, SC
National Provider Identifier
1174953475
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Physical Therapy Assistant
- License
- 3497
- Practice address
- 2300 Clemson Rd
Columbia, SC 29229-6872 - Phone
- (803) 400-8881
- NPI assigned
- Nov 22, 2013
- Sex
- Male
- 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 Therapy Assistant | 225200000X | 3497 | SC | Primary |
Addresses
Primary practice location
2300 Clemson Rd
Columbia, SC 29229-6872
Mailing address
2300 Clemson Rd
Columbia, SC 29229-6872
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 |
|---|---|---|---|
| 3497 | SC | MD | Speech-Language Pathologist |
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1385078400000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1463961600000",
"number": "1174953475",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "2300 CLEMSON RD",
"city": "COLUMBIA",
"state": "SC",
"postal_code": "292296872"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "2300 CLEMSON RD",
"city": "COLUMBIA",
"state": "SC",
"postal_code": "292296872",
"telephone_number": "803-400-8881"
}
],
"practiceLocations": [],
"basic": {
"last_name": "GOODWILL",
"first_name": "KEVIN",
"middle_name": "TODD",
"credential": "PTA",
"sole_proprietor": "NO",
"sex": "M",
"enumeration_date": "2013-11-22",
"last_updated": "2016-05-23",
"status": "A"
},
"taxonomies": [
{
"code": "225200000X",
"taxonomy_group": "",
"desc": "Physical Therapy Assistant",
"state": "SC",
"license": "3497",
"primary": true
}
],
"identifiers": [],
"endpoints": [],
"other_names": []
}Other providers in Columbia, SC
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on May 23, 2016; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.