Individual
ELLIE GOLDENSE
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
F
Credential
LAT, ATC
Contact information
Practice address
814 TULLY ST, HURLBURT FIELD, FL 32544-5744
(850) 312-8220
Mailing address
2004 98 PALMS BLVD UNIT 4221, DESTIN, FL 32541-2777
(508) 259-9898
Taxonomy
Speciality
Code
Description
License number
State
2255A2300X
Athletic Trainer
Primary
004194
NY
Other
Enumeration date
04/16/2021
Last updated
04/16/2021
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