Provider Demographics
NPI:1083742613
Name:GODGES, JOSEPH JOHN (DPT)
Entity Type:Individual
Prefix:
First Name:JOSEPH
Middle Name:JOHN
Last Name:GODGES
Suffix:
Gender:M
Credentials:DPT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2109 MOUNT CALVARY RD
Mailing Address - Street 2:
Mailing Address - City:SANTA BARBARA
Mailing Address - State:CA
Mailing Address - Zip Code:93105-2355
Mailing Address - Country:US
Mailing Address - Phone:310-365-6470
Mailing Address - Fax:866-644-1472
Practice Address - Street 1:15200 W SUNSET BLVD
Practice Address - Street 2:SUITE 111
Practice Address - City:PACIFIC PALISADES
Practice Address - State:CA
Practice Address - Zip Code:90272-3619
Practice Address - Country:US
Practice Address - Phone:310-573-9340
Practice Address - Fax:310-573-9328
Is Sole Proprietor?:No
Enumeration Date:2007-03-02
Last Update Date:2013-02-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAPT 124302251X0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2251X0800XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical TherapistOrthopedic
Provider Identifiers
StateIdentifier IDID TypeIssuer
CA0PT124300OtherBLUE SHIELD OF CALIFORNIA
CAFO605ZMedicare PIN