Individual
CHRISTOPHER ALLEN GOULT
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
PT, DPT
Contact information
Practice address
2295 TOWNE LAKE PKWY, STE 148, WOODSTOCK, GA 30189-5520
(770) 926-2744
(770) 926-2794
Mailing address
8823 PRODUCTION LN, OOLTEWAH, TN 37363-6511
(423) 238-7217
(423) 362-8684
Taxonomy
Speciality
Code
Description
License number
State
225100000X
Physical Therapist
05010868A
IN
225100000X
Physical Therapist
Primary
PT011818
GA
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
201110310
—
IN
Enumeration date
06/12/2012
Last updated
02/24/2017
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