Individual
TANISHA GODBOLT
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
F
Contact information
Practice address
9147 MOSS COVE CT, CHARLOTTE, NC 28227-8703
(832) 794-7264
Mailing address
9147 MOSS COVE CT, CHARLOTTE, NC 28227-8703
(832) 794-7264
Taxonomy
Speciality
Code
Description
License number
State
335E00000X
Prosthetic/Orthotic Supplier
Primary
054857
CT
Other
Enumeration date
02/02/2021
Last updated
05/19/2022
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