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Individual

CHAD J. GOUDY

Active
Sole proprietor
No

Provider details

NPI number
Gender
Man
Credential
PT, DPT, CMTPT

Contact information

Practice address
9980 BROOK RD UNIT 16, GLEN ALLEN, VA 23059-6501
(804) 550-5730
(804) 550-5733
Mailing address
PO BOX 69030, BALTIMORE, MD 21264-9030
(757) 873-2302
(757) 873-2306

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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