Individual
CRYSTAL WALLACE GODDIN
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
PTA
Contact information
Practice address
1104 N MAIN ST, BUSHNELL, FL, BUSHNELL, FL 33513
(352) 568-8777
Mailing address
391 CR 549, BUSHNELL, FL 33513
(352) 603-1380
Taxonomy
Speciality
Code
Description
License number
State
225200000X
Physical Therapy Assistant
Primary
23675
FL
Other
Enumeration date
04/27/2018
Last updated
04/27/2018
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