Individual
BRUCE GOUDELOCK
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
Man
Credential
MSPT
Contact information
Practice address
482 BRYAN AVE, SALT LAKE CITY, UT 84115-1714
(801) 585-2119
Mailing address
482 BRYAN AVE, SALT LAKE CITY, UT 84115-1714
Taxonomy
Speciality
Code
Description
License number
State
225100000X
Physical Therapist
Primary
5078923-2401
UT
Other
Enumeration date
06/08/2011
Last updated
12/27/2021
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