Individual
BRYAN GODBOUT
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
Man
Contact information
Practice address
3535 KIRBY PKWY, MEMPHIS, TN 38115-3721
(612) 229-3615
Mailing address
1796 CRUMP AVE, MEMPHIS, TN 38107-4513
(612) 229-3615
Taxonomy
Speciality
Code
Description
License number
State
225200000X
Physical Therapy Assistant
Primary
7578
TN
Other
Enumeration date
04/23/2022
Last updated
04/23/2022
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