Provider Demographics
NPI:1003924242
Name:GODLEY, KAREN
Entity Type:Individual
Prefix:
First Name:KAREN
Middle Name:
Last Name:GODLEY
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:7375 SILVER PINE DR
Mailing Address - Street 2:
Mailing Address - City:SPRINGFIELD
Mailing Address - State:VA
Mailing Address - Zip Code:22153-1819
Mailing Address - Country:US
Mailing Address - Phone:703-569-3966
Mailing Address - Fax:
Practice Address - Street 1:6910 RICHMOND HWY STE 200
Practice Address - Street 2:
Practice Address - City:ALEXANDRIA
Practice Address - State:VA
Practice Address - Zip Code:22306-1801
Practice Address - Country:US
Practice Address - Phone:703-765-7700
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2006-08-28
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist
Provider Identifiers
StateIdentifier IDID TypeIssuer
VA2305202716OtherLICENSE #