Individual
ELLIS AUSTIN GOODWIN
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
Man
Contact information
Practice address
3799 12TH STREET EXT STE 100, CAYCE, SC 29033-3750
(803) 926-6810
Mailing address
7308 COACHMAKER RD, COLUMBIA, SC 29209-2406
(843) 751-6815
Taxonomy
Speciality
Code
Description
License number
State
225100000X
Physical Therapist
Primary
12983
SC
390200000X
Student in an Organized Health Care Education/Training Program
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Other
Enumeration date
06/18/2025
Last updated
03/18/2026
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