Provider Demographics
NPI:1750813804
Name:GOOD, JOSHUA MARTIN (PTA)
Entity type:Individual
Prefix:
First Name:JOSHUA
Middle Name:MARTIN
Last Name:GOOD
Suffix:
Gender:M
Credentials:PTA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4289 EVERETT AVE
Mailing Address - Street 2:
Mailing Address - City:SPRING HILL
Mailing Address - State:FL
Mailing Address - Zip Code:34609-2206
Mailing Address - Country:US
Mailing Address - Phone:352-442-7255
Mailing Address - Fax:
Practice Address - Street 1:3363 W. WATERS AVENUE, SUITE 700
Practice Address - Street 2:
Practice Address - City:TAMPA
Practice Address - State:FL
Practice Address - Zip Code:33614
Practice Address - Country:US
Practice Address - Phone:813-932-5119
Practice Address - Fax:813-932-5539
Is Sole Proprietor?:Yes
Enumeration Date:2017-03-29
Last Update Date:2017-03-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLPTA27293225200000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225200000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapy Assistant