Provider Demographics
NPI:1801988910
Name:GOODMAN, EDWARD TITUS III (PT)
Entity type:Individual
Prefix:
First Name:EDWARD
Middle Name:TITUS
Last Name:GOODMAN
Suffix:III
Gender:M
Credentials:PT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1660 OSCAR PATTERSON RD
Mailing Address - Street 2:
Mailing Address - City:NEW MARKET
Mailing Address - State:AL
Mailing Address - Zip Code:35761-9418
Mailing Address - Country:US
Mailing Address - Phone:256-348-2144
Mailing Address - Fax:
Practice Address - Street 1:4825 UNIVERSITY SQ
Practice Address - Street 2:SUITE 9
Practice Address - City:HUNTSVILLE
Practice Address - State:AL
Practice Address - Zip Code:35816-1826
Practice Address - Country:US
Practice Address - Phone:256-348-2144
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2006-09-28
Last Update Date:2015-08-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
ALPTH4539225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist