Individual
JOHN TYLER GOODPASTURE
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
PT, DPT
Contact information
Practice address
2100 W MAIN ST, RUSSELLVILLE, AR 72801-2758
(479) 968-2525
(479) 968-2538
Mailing address
2100 W MAIN ST, RUSSELLVILLE, AR 72801-2758
(479) 968-2525
(479) 968-2538
Taxonomy
Speciality
Code
Description
License number
State
225100000X
Physical Therapist
Primary
PT4710
AR
Other
Enumeration date
08/28/2019
Last updated
08/28/2019
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