Provider Demographics
NPI:1386823813
Name:GODETT, NICOLE CARMEN (PT)
Entity Type:Individual
Prefix:DR
First Name:NICOLE
Middle Name:CARMEN
Last Name:GODETT
Suffix:
Gender:F
Credentials:PT
Other - Prefix:
Other - First Name:NICOLE
Other - Middle Name:CARMEN
Other - Last Name:MULLIS
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:801 SONJA AVE
Mailing Address - Street 2:
Mailing Address - City:RIDGECREST
Mailing Address - State:CA
Mailing Address - Zip Code:93555-3358
Mailing Address - Country:US
Mailing Address - Phone:760-382-3882
Mailing Address - Fax:760-301-5408
Practice Address - Street 1:901 N HERITAGE DR STE 106
Practice Address - Street 2:
Practice Address - City:RIDGECREST
Practice Address - State:CA
Practice Address - Zip Code:93555-5541
Practice Address - Country:US
Practice Address - Phone:760-301-5411
Practice Address - Fax:760-301-5408
Is Sole Proprietor?:Yes
Enumeration Date:2007-11-01
Last Update Date:2020-09-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA34154225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist