Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 2251X0800X | Physical Therapist - Orthopedic | PT 12430 | CA |
NPI | 1083742613 |
---|---|
Provider Name | Joseph John Godges |
First Address | Santa Barbara, CA 93105-2355 |
Second Address | Pacific Palisades, CA 90272-3619 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 02/03/2007 |
Last Update Date | 07/02/2013 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
0PT124300 | BLUE SHIELD OF CALIFORNIA (01) | CA |