Provider Demographics
NPI:1730707928
Name:GOODSON, DARA GREEN (DPT)
Entity type:Individual
Prefix:
First Name:DARA
Middle Name:GREEN
Last Name:GOODSON
Suffix:
Gender:F
Credentials:DPT
Other - Prefix:
Other - First Name:DARA
Other - Middle Name:ELZENA
Other - Last Name:GREEN
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:DPT
Mailing Address - Street 1:3660 MCCONNELL RD APT 2H
Mailing Address - Street 2:
Mailing Address - City:GREENSBORO
Mailing Address - State:NC
Mailing Address - Zip Code:27405-9780
Mailing Address - Country:US
Mailing Address - Phone:704-770-7081
Mailing Address - Fax:
Practice Address - Street 1:1302 OLD COX RD
Practice Address - Street 2:
Practice Address - City:ASHEBORO
Practice Address - State:NC
Practice Address - Zip Code:27205-9466
Practice Address - Country:US
Practice Address - Phone:336-629-7811
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2020-07-14
Last Update Date:2024-03-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NCP19541225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist