Provider Demographics
NPI:1528561065
Name:GODISH, ANDY PAUL (ATC, LAT)
Entity Type:Individual
Prefix:MR
First Name:ANDY
Middle Name:PAUL
Last Name:GODISH
Suffix:
Gender:M
Credentials:ATC, LAT
Other - Prefix:MR
Other - First Name:ANDREW
Other - Middle Name:PAUL
Other - Last Name:GODISH
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:ATC, LAT
Mailing Address - Street 1:2202 FALKIRK DR
Mailing Address - Street 2:
Mailing Address - City:COLORADO SPRINGS
Mailing Address - State:CO
Mailing Address - Zip Code:80910-3266
Mailing Address - Country:US
Mailing Address - Phone:814-659-7105
Mailing Address - Fax:
Practice Address - Street 1:2202 FALKIRK DR
Practice Address - Street 2:
Practice Address - City:COLORADO SPRINGS
Practice Address - State:CO
Practice Address - Zip Code:80910-3266
Practice Address - Country:US
Practice Address - Phone:814-659-7105
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2018-03-12
Last Update Date:2018-03-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
COAT.00014832255A2300X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2255A2300XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersSpecialist/TechnologistAthletic Trainer