Provider Demographics
NPI:1861666596
Name:GOODALL, ROCKY J (BOCP/L)
Entity type:Individual
Prefix:
First Name:ROCKY
Middle Name:J
Last Name:GOODALL
Suffix:
Gender:M
Credentials:BOCP/L
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Credentials:
Mailing Address - Street 1:6017 LICKTON PIKE
Mailing Address - Street 2:
Mailing Address - City:GOODLETTSVILLE
Mailing Address - State:TN
Mailing Address - Zip Code:37072-9146
Mailing Address - Country:US
Mailing Address - Phone:615-772-1880
Mailing Address - Fax:615-340-0028
Practice Address - Street 1:114 POWELL DR
Practice Address - Street 2:
Practice Address - City:HENDERSONVILLE
Practice Address - State:TN
Practice Address - Zip Code:37075-3527
Practice Address - Country:US
Practice Address - Phone:615-340-0068
Practice Address - Fax:615-340-0028
Is Sole Proprietor?:Yes
Enumeration Date:2008-04-14
Last Update Date:2008-04-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TNC36377335E00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes335E00000XSuppliersProsthetic/Orthotic Supplier