Provider Demographics
NPI:1467875658
Name:GOODALL, RHONDA MARCIA (LMT, MMP)
Entity Type:Individual
Prefix:
First Name:RHONDA
Middle Name:MARCIA
Last Name:GOODALL
Suffix:
Gender:F
Credentials:LMT, MMP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 568373
Mailing Address - Street 2:
Mailing Address - City:ORLANDO
Mailing Address - State:FL
Mailing Address - Zip Code:32856-8373
Mailing Address - Country:US
Mailing Address - Phone:407-547-5576
Mailing Address - Fax:
Practice Address - Street 1:7575 KINGSPOINTE PKWY
Practice Address - Street 2:SUITE 21
Practice Address - City:ORLANDO
Practice Address - State:FL
Practice Address - Zip Code:32819-8517
Practice Address - Country:US
Practice Address - Phone:407-547-5576
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2014-01-24
Last Update Date:2014-07-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLMA59371171W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes171W00000XOther Service ProvidersContractor