Individual
KEVIN TODD GOODWILL
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
PTA
Contact information
Practice address
2300 CLEMSON RD, COLUMBIA, SC 29229-6872
(803) 400-8881
Mailing address
2300 CLEMSON RD, COLUMBIA, SC 29229-6872
Taxonomy
Speciality
Code
Description
License number
State
225200000X
Physical Therapy Assistant
Primary
3497
SC
Other
Enumeration date
11/22/2013
Last updated
05/23/2016
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