Provider Demographics
NPI:1437268182
Name:GODDARD, ERNEST CLAUDE (PT)
Entity Type:Individual
Prefix:MR
First Name:ERNEST
Middle Name:CLAUDE
Last Name:GODDARD
Suffix:
Gender:M
Credentials:PT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Credentials:
Mailing Address - Street 1:4273 KEATON CROSSING BLVD
Mailing Address - Street 2:
Mailing Address - City:O FALLON
Mailing Address - State:MO
Mailing Address - Zip Code:63368-8220
Mailing Address - Country:US
Mailing Address - Phone:636-206-4225
Mailing Address - Fax:636-422-1051
Practice Address - Street 1:1300 VETERANS BLVD
Practice Address - Street 2:SUITE C
Practice Address - City:FESTUS
Practice Address - State:MO
Practice Address - Zip Code:63028-2394
Practice Address - Country:US
Practice Address - Phone:636-931-2100
Practice Address - Fax:636-931-2300
Is Sole Proprietor?:No
Enumeration Date:2006-08-29
Last Update Date:2019-07-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MO114775225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist
Provider Identifiers
StateIdentifier IDID TypeIssuer
MO000025158Medicare ID - Type Unspecified