Active NPI
Stephen Goodnough, PTA
- Physical Therapy Assistant
- Coupeville, WA
National Provider Identifier
1790919629
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Physical Therapy Assistant
- License
- 60045654
- Practice address
- 311 NE 3Rd St
Coupeville, WA 98239-3427 - Phone
- (360) 678-2273
- Fax
- (360) 678-8715
- NPI assigned
- May 6, 2009
- 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 | 60045654 | WA | Primary |
Addresses
Primary practice location
311 NE 3Rd St
Coupeville, WA 98239-3427
Mailing address
PO Box 31
Clinton, WA 98236-0031
Phone (360) 678-2273
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 |
|---|---|---|---|
| 60045654 | WA | MD | Physical Therapy Assistant |
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1241568000000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1241568000000",
"number": "1790919629",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "PO BOX 31",
"city": "CLINTON",
"state": "WA",
"postal_code": "982360031",
"telephone_number": "360-678-2273",
"fax_number": "360-678-8715"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "311 NE 3RD ST",
"city": "COUPEVILLE",
"state": "WA",
"postal_code": "982393427",
"telephone_number": "360-678-2273",
"fax_number": "360-678-8715"
}
],
"practiceLocations": [],
"basic": {
"last_name": "GOODNOUGH",
"first_name": "STEPHEN",
"name_prefix": "Mr.",
"credential": "PTA",
"sole_proprietor": "NO",
"sex": "M",
"enumeration_date": "2009-05-06",
"last_updated": "2009-05-06",
"status": "A"
},
"taxonomies": [
{
"code": "225200000X",
"taxonomy_group": "",
"desc": "Physical Therapy Assistant",
"state": "WA",
"license": "60045654",
"primary": true
}
],
"identifiers": [],
"endpoints": [],
"other_names": []
}Other providers in Coupeville, WA
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on May 6, 2009; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.