Individual
AMBER GODDARD
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Contact information
Practice address
201 LAFAYETTE AVE, MATTOON, IL 61938-4409
(217) 235-5549
Mailing address
201 LAFAYETTE AVE, MATTOON, IL 61938-4409
(217) 235-5549
Taxonomy
Speciality
Code
Description
License number
State
225200000X
Physical Therapy Assistant
Primary
160.005690
IL
Other
Enumeration date
09/28/2012
Last updated
09/28/2012
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