Individual
MS. TIFFANY RENEE GODBOLT
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
F
Credential
P.T.A.
Contact information
Practice address
318 E MAIN ST, LAKE CITY, SC 29560-2116
(843) 374-3353
(843) 374-7245
Mailing address
1057 KINNEY CT, SELLERS, SC 29592-8001
(843) 758-4738
Taxonomy
Speciality
Code
Description
License number
State
225200000X
Physical Therapy Assistant
Primary
1980
SC
Other
Enumeration date
05/15/2013
Last updated
06/03/2013
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