Individual
MR. BRYCE THOMAS GOODALL
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Contact information
Practice address
725 COLONIAL DR, MACHESNEY PARK, IL 61115-3715
(815) 520-9260
Mailing address
725 COLONIAL DR, MACHESNEY PARK, IL 61115-3715
(815) 520-9260
Taxonomy
Speciality
Code
Description
License number
State
2255A2300X
Athletic Trainer
Primary
—
—
Other
Enumeration date
04/30/2018
Last updated
04/30/2018
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