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Individual

MACKENZIE GOULD

Active
Sole proprietor
No

Provider details

NPI number
Gender
F

Contact information

Practice address
621 E ALEXANDER ST FL 33563, PLANT CITY, FL 33563-7126
(813) 707-1509
Mailing address
5006 TWIN PINE DR, PLANT CITY, FL 33566-7977
(813) 751-7846

Taxonomy

Speciality
Code
Description
License number
State
225200000X
Physical Therapy Assistant
Primary
31697
FL

Other

Other identifiers
Code
Description
Identifier
Issuer
State
05
12345
FL
Enumeration date
02/01/2022
Last updated
02/01/2022
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