Active NPI
Edith Shunk Goodwin, PT
- Pediatric Physical Therapist
- Council Bluffs, IA
National Provider Identifier
1982750352
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Pediatric Physical Therapist
- License
- 00987
- Practice address
- 2600 S 9TH St
Council Bluffs, IA 51501-7541 - Phone
- (712) 322-7354
- Fax
- (712) 322-7419
- NPI assigned
- Jan 26, 2007
- 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 |
|---|---|---|---|---|
| Pediatric Physical Therapist | 2251P0200X | 00987 | IA | Primary |
Addresses
Primary practice location
2600 S 9TH St
Council Bluffs, IA 51501-7541
Mailing address
1918 Avenue B
Council Bluffs, IA 51501-2438
Phone (712) 322-2903
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 |
|---|---|---|---|
| 00987 | IA | MD | Pediatric Physical Therapist |
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1169769600000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1183852800000",
"number": "1982750352",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "1918 AVENUE B",
"city": "COUNCIL BLUFFS",
"state": "IA",
"postal_code": "515012438",
"telephone_number": "712-322-2903"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "2600 S 9TH ST",
"city": "COUNCIL BLUFFS",
"state": "IA",
"postal_code": "515017541",
"telephone_number": "712-322-7354",
"fax_number": "712-322-7419"
}
],
"practiceLocations": [],
"basic": {
"last_name": "GOODWIN",
"first_name": "EDITH",
"middle_name": "SHUNK",
"credential": "PT",
"sole_proprietor": "NO",
"sex": "F",
"enumeration_date": "2007-01-26",
"last_updated": "2007-07-08",
"status": "A"
},
"taxonomies": [
{
"code": "2251P0200X",
"taxonomy_group": "",
"desc": "Physical Therapist, Pediatrics",
"state": "IA",
"license": "00987",
"primary": true
}
],
"identifiers": [],
"endpoints": [],
"other_names": []
}Other providers in Council Bluffs, IA
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jul 8, 2007; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.