Provider Demographics
NPI:1598074908
Name:GODIN, BENJAMIN D (PT, DPT)
Entity Type:Individual
Prefix:DR
First Name:BENJAMIN
Middle Name:D
Last Name:GODIN
Suffix:
Gender:M
Credentials:PT, DPT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1519 CENTRAL ST
Mailing Address - Street 2:
Mailing Address - City:STOUGHTON
Mailing Address - State:MA
Mailing Address - Zip Code:02072-4415
Mailing Address - Country:US
Mailing Address - Phone:781-297-0979
Mailing Address - Fax:781-297-3703
Practice Address - Street 1:97 GREEN ST
Practice Address - Street 2:2ND FLOOR
Practice Address - City:FOXBORO
Practice Address - State:MA
Practice Address - Zip Code:02035-2865
Practice Address - Country:US
Practice Address - Phone:774-215-5401
Practice Address - Fax:774-215-0029
Is Sole Proprietor?:No
Enumeration Date:2010-10-03
Last Update Date:2014-02-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MA19296225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist
Provider Identifiers
StateIdentifier IDID TypeIssuer
MAPT0187Medicare PIN