Individual
CHAD J. GOUDY
Active
Individual
CHAD J. GOUDY
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
PT, DPT, CMTPT
Taxonomy
Speciality
Code
Description
License number
State
225100000X
Physical Therapist
Primary
2305209518
VA
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
1154701597
MEDICAID QMB PROVIDER ID
VA
01
—
C05954
GROUP MEDICARE PTAN
VA
Enumeration date
06/01/2015
Last updated
04/16/2018
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