Individual
JONATHAN HANCOCK GOODMAN
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
DPT
Contact information
Practice address
1800 FLANDRO DR STE 190, POCATELLO, ID 83202-4940
(208) 233-2248
(208) 233-0219
Mailing address
1800 FLANDRO DR STE 190, POCATELLO, ID 83202-4940
(208) 233-2248
(208) 233-0219
Taxonomy
Speciality
Code
Description
License number
State
225100000X
Physical Therapist
Primary
PT-6416
ID
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
PT-6416
STATE LICENSE
ID
Enumeration date
05/15/2019
Last updated
08/05/2025
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