Individual
TONYA GODUSH
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Contact information
Practice address
2401 WIXSON ST APT F, WYNNE, AR 72396-4058
(870) 318-5092
Mailing address
2401 WIXSON ST APT F, WYNNE, AR 72396-4058
Taxonomy
Speciality
Code
Description
License number
State
225200000X
Physical Therapy Assistant
Primary
PTA 1953
AR
Other
Enumeration date
04/04/2012
Last updated
04/04/2012
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