Individual
PEGGY GOODMAN
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
F
Credential
P.T.
Contact information
Practice address
610 18TH ST, RUPERT, ID 83350-1027
(208) 431-3444
Mailing address
610 18TH ST, RUPERT, ID 83350-1027
(208) 431-3444
Taxonomy
Speciality
Code
Description
License number
State
225100000X
Physical Therapist
Primary
PT-253
ID
Other
Enumeration date
09/01/2014
Last updated
09/01/2014
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