Provider Demographics
NPI:1528355948
Name:GODWIN, TRACY J SR (LMT)
Entity type:Individual
Prefix:MR
First Name:TRACY
Middle Name:J
Last Name:GODWIN
Suffix:SR
Gender:M
Credentials:LMT
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Mailing Address - Street 1:211 S OCEAN BLVD
Mailing Address - Street 2:PLAZA DEL MAR
Mailing Address - City:LANTANA
Mailing Address - State:FL
Mailing Address - Zip Code:33462-3312
Mailing Address - Country:US
Mailing Address - Phone:561-533-9772
Mailing Address - Fax:561-533-9799
Practice Address - Street 1:211 S OCEAN BLVD
Practice Address - Street 2:PLAZA DEL MAR
Practice Address - City:LANTANA
Practice Address - State:FL
Practice Address - Zip Code:33462-3312
Practice Address - Country:US
Practice Address - Phone:561-533-9772
Practice Address - Fax:561-533-9799
Is Sole Proprietor?:Yes
Enumeration Date:2011-07-06
Last Update Date:2011-07-07
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Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225700000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersMassage Therapist