Individual
LACEY I GODBOLD
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
DPT
Contact information
Practice address
2600 BELLE CHASSE HWY, SUITE I, TERRYTOWN, LA 70056-7156
(504) 391-7670
(504) 378-9437
Mailing address
2600 BELLE CHASSE HWY, SUITE 208, TERRYTOWN, LA 70056-7156
(504) 433-8744
(504) 433-8740
Taxonomy
Speciality
Code
Description
License number
State
225100000X
Physical Therapist
Primary
07633
LA
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
07633
LOUISIANA PT LICENSE
LA
Enumeration date
07/18/2011
Last updated
02/06/2015
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