Provider Demographics
NPI:1366194862
Name:GOODWIN ELITE ORTHOBIOLOGICS AND WELLNESS PLLC
Entity type:Organization
Organization Name:GOODWIN ELITE ORTHOBIOLOGICS AND WELLNESS PLLC
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:CREDENTILAER
Authorized Official - Prefix:
Authorized Official - First Name:SANDY
Authorized Official - Middle Name:
Authorized Official - Last Name:FRIDAY
Authorized Official - Suffix:
Authorized Official - Credentials:CTP
Authorized Official - Phone:702-800-8988
Mailing Address - Street 1:100 N GREEN VALLEY PKWY STE 325
Mailing Address - Street 2:
Mailing Address - City:HENDERSON
Mailing Address - State:NV
Mailing Address - Zip Code:89074-6393
Mailing Address - Country:US
Mailing Address - Phone:702-722-6030
Mailing Address - Fax:
Practice Address - Street 1:100 N GREEN VALLEY PKWY STE 325
Practice Address - Street 2:
Practice Address - City:HENDERSON
Practice Address - State:NV
Practice Address - Zip Code:89074-6393
Practice Address - Country:US
Practice Address - Phone:702-722-6030
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2022-01-25
Last Update Date:2022-05-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes208100000XAllopathic & Osteopathic PhysiciansPhysical Medicine & RehabilitationGroup - Single Specialty