Basic Information
Provider Information
NPI: 1003001918
EntityType: 1
ReplacementNPI:  
OrganizationName:  
LastName: GOAD
FirstName: KAREN
MiddleName: KAY
NamePrefix:  
NameSuffix:  
Credential: PT
OtherOrganizationName:  
OtherOrganizationType:  
OtherLastName:  
OtherFirstName:  
OtherMiddleName:  
OtherNamePrefix:  
OtherNameSuffix:  
OtherCredential:  
OtherLastNameType:  
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
NPIDeactivationReasonCode:  
NPIDeactivationDate:  
NPIReactivationDate:  
ProviderGenderCode: F
AuthorizedOfficialLastName:  
AuthorizedOfficialFirstName:  
AuthorizedOfficialMiddleName:  
AuthorizedOfficialTitleorPosition:  
AuthorizedOfficialTelephone:  
IsSoleProprietor: Y
IsOrganizationSubpart:  
ParentOrganizationLBN:  
AuthorizedOfficialNamePrefix:  
AuthorizedOfficialNameSuffix:  
AuthorizedOfficialCredential:  

Taxonomy Information
TaxonomyLicenseStateSwitchTaxonomyGroupTaxonomyTypeTaxonomyClassSubSpecialty
225100000X1008803TXY Respiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist 
2251E1300X1008803TXN Respiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical TherapistElectrophysiology, Clinical

No ID Information.


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