Provider Demographics
NPI:1497921159
Name:GOULET, JOANNE (PT)
Entity Type:Individual
Prefix:
First Name:JOANNE
Middle Name:
Last Name:GOULET
Suffix:
Gender:F
Credentials:PT
Other - Prefix:
Other - First Name:JOANNE
Other - Middle Name:
Other - Last Name:RYON
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:PT
Mailing Address - Street 1:1722 KINGSWOOD RD
Mailing Address - Street 2:
Mailing Address - City:JACKSONVILLE
Mailing Address - State:FL
Mailing Address - Zip Code:32207-5429
Mailing Address - Country:US
Mailing Address - Phone:904-374-9323
Mailing Address - Fax:
Practice Address - Street 1:1320 ROBERTS DR
Practice Address - Street 2:
Practice Address - City:JACKSONVILLE BEACH
Practice Address - State:FL
Practice Address - Zip Code:32250-3253
Practice Address - Country:US
Practice Address - Phone:904-627-1480
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2008-05-02
Last Update Date:2012-02-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLPT8181225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist