Basic Information
| Provider Information | |||||||||
| NPI: | 1003001918 | ||||||||
| EntityType: | 1 | ||||||||
| ReplacementNPI: | |||||||||
| OrganizationName: | |||||||||
| LastName: | GOAD | ||||||||
| FirstName: | KAREN | ||||||||
| MiddleName: | KAY | ||||||||
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| Credential: | PT | ||||||||
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| Mailing Information | |||||||||
| Address1: | 45 IDLEWILD ST | ||||||||
| Address2: | |||||||||
| City: | LUMBERTON | ||||||||
| State: | TX | ||||||||
| PostalCode: | 776576934 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 4097552570 | ||||||||
| FaxNumber: | 4093852502 | ||||||||
| Practice Location | |||||||||
| Address1: | 1162 HWY 327 EAST | ||||||||
| Address2: | |||||||||
| City: | SILSBEE | ||||||||
| State: | TX | ||||||||
| PostalCode: | 77656 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 4093852500 | ||||||||
| FaxNumber: | 4093852502 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 09/13/2007 | ||||||||
| LastUpdateDate: | 09/13/2007 | ||||||||
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| ProviderGenderCode: | F | ||||||||
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| IsSoleProprietor: | Y | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 225100000X | 1008803 | TX | Y | Respiratory, Developmental, Rehabilitative and Restorative Service Providers | Physical Therapist | 2251E1300X | 1008803 | TX | N | Respiratory, Developmental, Rehabilitative and Restorative Service Providers | Physical Therapist | Electrophysiology, Clinical |
No ID Information.