Provider Demographics
NPI:1700169935
Name:GOODSELL TONG WHITTLE, LILY M (LMT, SET)
Entity Type:Individual
Prefix:MRS
First Name:LILY
Middle Name:M
Last Name:GOODSELL TONG WHITTLE
Suffix:
Gender:F
Credentials:LMT, SET
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:7010 SHELDON RD
Mailing Address - Street 2:SUITE #700
Mailing Address - City:TAMPA
Mailing Address - State:FL
Mailing Address - Zip Code:33615-2324
Mailing Address - Country:US
Mailing Address - Phone:813-817-9299
Mailing Address - Fax:
Practice Address - Street 1:7010 SHELDON RD
Practice Address - Street 2:SUITE #700
Practice Address - City:TAMPA
Practice Address - State:FL
Practice Address - Zip Code:33615-2324
Practice Address - Country:US
Practice Address - Phone:813-817-9299
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2011-09-23
Last Update Date:2011-09-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLMA61380225400000X
MA61380225700000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225700000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersMassage Therapist
No225400000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersRehabilitation Practitioner