Basic Information
| Provider Information | |||||||||
| NPI: | 1376877357 | ||||||||
| EntityType: | 1 | ||||||||
| ReplacementNPI: | |||||||||
| OrganizationName: | |||||||||
| LastName: | GOODE | ||||||||
| FirstName: | ELIZABETH | ||||||||
| MiddleName: | JAYNE | ||||||||
| NamePrefix: | |||||||||
| NameSuffix: | |||||||||
| Credential: | PT | ||||||||
| OtherOrganizationName: | |||||||||
| OtherOrganizationType: | |||||||||
| OtherLastName: | SHAWVER-GOODE | ||||||||
| OtherFirstName: | BETH | ||||||||
| OtherMiddleName: | |||||||||
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| OtherCredential: | PT | ||||||||
| OtherLastNameType: | 5 | ||||||||
| Mailing Information | |||||||||
| Address1: | 304 WEST WEAVER STREET | ||||||||
| Address2: | STE 103 BALANCED PHYSICAL THERAPY | ||||||||
| City: | CARRBORO | ||||||||
| State: | NC | ||||||||
| PostalCode: | 275102079 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 9199420240 | ||||||||
| FaxNumber: | 9199420280 | ||||||||
| Practice Location | |||||||||
| Address1: | 304 W WEAVER ST | ||||||||
| Address2: | STE 103 | ||||||||
| City: | CARRBORO | ||||||||
| State: | NC | ||||||||
| PostalCode: | 275102084 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 9199420240 | ||||||||
| FaxNumber: | 9199420280 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 09/24/2009 | ||||||||
| LastUpdateDate: | 06/27/2011 | ||||||||
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| ProviderGenderCode: | F | ||||||||
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| IsSoleProprietor: | N | ||||||||
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| NPICertificationDate: | |||||||||
Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 225100000X | 7340 | NC | Y | Respiratory, Developmental, Rehabilitative and Restorative Service Providers | Physical Therapist |
No ID Information.