Provider Demographics
NPI:1487466975
Name:GOOD, JOHN HENRY
Entity type:Individual
Prefix:
First Name:JOHN
Middle Name:HENRY
Last Name:GOOD
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:11398 BELMONT LAKE DR UNIT 103
Mailing Address - Street 2:
Mailing Address - City:LAS VEGAS
Mailing Address - State:NV
Mailing Address - Zip Code:89135-1375
Mailing Address - Country:US
Mailing Address - Phone:702-375-4194
Mailing Address - Fax:
Practice Address - Street 1:11398 BELMONT LAKE DR UNIT 103
Practice Address - Street 2:
Practice Address - City:LAS VEGAS
Practice Address - State:NV
Practice Address - Zip Code:89135-1375
Practice Address - Country:US
Practice Address - Phone:702-375-4194
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2025-01-22
Last Update Date:2025-01-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NVNVMT.12989225700000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225700000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersMassage Therapist