Individual
MRS. LAURA CARYN GOFORTH
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
LPTA
Contact information
Practice address
1653 TEMPLE AVE N, FAYETTE, AL 35555-1314
(205) 932-5966
(205) 932-1354
Mailing address
1603 RUTLEDGE LN, JASPER, AL 35503-6309
Taxonomy
Speciality
Code
Description
License number
State
225200000X
Physical Therapy Assistant
Primary
6167
AL
Other
Enumeration date
10/31/2012
Last updated
10/31/2012
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