Individual
RENAE GOODELL
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
F
Credential
PTA, LMP
Contact information
Practice address
7405 38TH DR SE, LACEY, WA 98503-7106
(336) 327-8975
Mailing address
7405 38TH DR SE, LACEY, WA 98503-7106
(336) 327-8975
Taxonomy
Speciality
Code
Description
License number
State
225200000X
Physical Therapy Assistant
Primary
60046677
WA
225700000X
Massage Therapist
MA 60453128
WA
Other
Enumeration date
11/29/2012
Last updated
09/25/2014
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