Provider Demographics
NPI:1164593752
Name:GODNIG, DORA (PT)
Entity Type:Individual
Prefix:
First Name:DORA
Middle Name:
Last Name:GODNIG
Suffix:
Gender:F
Credentials:PT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:66 S COURTLAND ST
Mailing Address - Street 2:# 101
Mailing Address - City:EAST STROUDSBURG
Mailing Address - State:PA
Mailing Address - Zip Code:18301-2827
Mailing Address - Country:US
Mailing Address - Phone:570-420-0606
Mailing Address - Fax:570-420-0646
Practice Address - Street 1:66 S COURTLAND ST
Practice Address - Street 2:# 101
Practice Address - City:EAST STROUDSBURG
Practice Address - State:PA
Practice Address - Zip Code:18301-2827
Practice Address - Country:US
Practice Address - Phone:570-420-0606
Practice Address - Fax:570-420-0646
Is Sole Proprietor?:No
Enumeration Date:2006-11-13
Last Update Date:2017-03-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PAPT015221225100000X
NJ40QA01196200225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist
Provider Identifiers
StateIdentifier IDID TypeIssuer
PA001306674OtherHIGHMARK BCBS
PA822475OtherFIRST PRIORITY HEALTH
PA12314121OtherMULTIPLAN
PA096521Medicare PIN
NJ112282Medicare PIN
PA001306674OtherHIGHMARK BCBS
PADF4056Medicare PIN
NJ114254WUZMedicare Oscar/Certification
NJDQ8616Medicare PIN
PA822475OtherFIRST PRIORITY HEALTH