Individual
JARED PAUL GOUGHNOUR
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
Man
Credential
PTA
Contact information
Practice address
524 2ND ST, HIGHSPIRE, PA 17034-1506
(717) 649-0055
Mailing address
524 2ND ST, HIGHSPIRE, PA 17034-1506
(717) 649-0055
Taxonomy
Speciality
Code
Description
License number
State
225200000X
Physical Therapy Assistant
Primary
TEI001301
PA
Other
Enumeration date
05/17/2011
Last updated
05/17/2011
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