Active NPI
Bob Wayne Goodman Jr., PT
- Physical Therapist
- Fort Collins, CO
National Provider Identifier
1225283112
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Physical Therapist
- License
- 9119
- Practice address
- 508 W Trilby Rd
Fort Collins, CO 80525-4054 - Phone
- (970) 226-6408
- NPI assigned
- Nov 19, 2008
- 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 Therapist | 225100000X | 9119 | CO | Primary |
Addresses
Primary practice location
508 W Trilby Rd
Fort Collins, CO 80525-4054
Mailing address
508 W Trilby Rd
Fort Collins, CO 80525-4054
Phone (970) 226-6408
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 |
|---|---|---|---|
| 9119 | CO | MD | Massage Therapist |
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1227052800000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1227052800000",
"number": "1225283112",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "508 W TRILBY RD",
"city": "FORT COLLINS",
"state": "CO",
"postal_code": "805254054",
"telephone_number": "970-226-6408"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "508 W TRILBY RD",
"city": "FORT COLLINS",
"state": "CO",
"postal_code": "805254054",
"telephone_number": "970-226-6408"
}
],
"practiceLocations": [],
"basic": {
"last_name": "GOODMAN",
"first_name": "BOB",
"middle_name": "WAYNE",
"name_prefix": "Mr.",
"name_suffix": "Jr.",
"credential": "PT",
"sole_proprietor": "NO",
"sex": "M",
"enumeration_date": "2008-11-19",
"last_updated": "2008-11-19",
"status": "A"
},
"taxonomies": [
{
"code": "225100000X",
"taxonomy_group": "",
"desc": "Physical Therapist",
"state": "CO",
"license": "9119",
"primary": true
}
],
"identifiers": [],
"endpoints": [],
"other_names": []
}Other providers in Fort Collins, CO
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Nov 19, 2008; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.