Provider Demographics
NPI:1538402649
Name:GOODE, BRIDGID MARIE (LMT)
Entity type:Individual
Prefix:
First Name:BRIDGID
Middle Name:MARIE
Last Name:GOODE
Suffix:
Gender:
Credentials:LMT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:5140 DEL REY BLVD
Mailing Address - Street 2:
Mailing Address - City:LAS CRUCES
Mailing Address - State:NM
Mailing Address - Zip Code:88012-7331
Mailing Address - Country:US
Mailing Address - Phone:516-532-5611
Mailing Address - Fax:
Practice Address - Street 1:5354 VIVERA LN
Practice Address - Street 2:
Practice Address - City:JACKSONVILLE
Practice Address - State:FL
Practice Address - Zip Code:32244-6901
Practice Address - Country:US
Practice Address - Phone:904-489-9708
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2013-03-27
Last Update Date:2025-05-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NMMT-2024-0025225700000X
FLMA106040225700000X
NM7430174400000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes174400000XOther Service ProvidersSpecialist
No225700000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersMassage Therapist