Individual
MRS. JENITA PAGE GOODWIN
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
PTA
Contact information
Practice address
303 N HURSTBOURNE PKWY, SUITE 200, LOUISVILLE, KY 40222-5185
(502) 412-5847
Mailing address
1515 N 11TH ST, VINCENNES, IN 47591-3304
Taxonomy
Speciality
Code
Description
License number
State
225200000X
Physical Therapy Assistant
Primary
06001163A
IN
Other
Enumeration date
10/15/2012
Last updated
10/15/2012
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