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1881061414
TANNER S GOULET
RUSSELLVILLE, AR
NPI
1881061414
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Entity Type
Individual
Gender
Male
Sole Proprietor ?
No
Primary Taxonomy
225200000X Physical Therapy Assistant
(Licence: AR PTA3934)
Enumeration Date
2015-08-31
Last Update Date
2015-08-31
Business Address
TANNER S GOULET PTA
1915 W MAIN ST
RUSSELLVILLE, AR 72801-2725
Phone number: 479-968-1198
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Mailing Address
TANNER S GOULET PTA
500 E 3RD ST
RUSSELLVILLE, AR 72801-5204
Phone number: 479-968-1198
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