Provider Demographics
NPI:1760663090
Name:GODOY, JENNA
Entity Type:Individual
Prefix:
First Name:JENNA
Middle Name:
Last Name:GODOY
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:JENNA
Other - Middle Name:
Other - Last Name:GODNY
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:1941 SAVAGE RD
Mailing Address - Street 2:SUITE 400C
Mailing Address - City:CHARLESTON
Mailing Address - State:SC
Mailing Address - Zip Code:29407-4704
Mailing Address - Country:US
Mailing Address - Phone:866-571-2700
Mailing Address - Fax:877-571-2124
Practice Address - Street 1:1941 SAVAGE RD
Practice Address - Street 2:SUITE 400C
Practice Address - City:CHARLESTON
Practice Address - State:SC
Practice Address - Zip Code:29407-4704
Practice Address - Country:US
Practice Address - Phone:866-571-2700
Practice Address - Fax:877-571-2124
Is Sole Proprietor?:No
Enumeration Date:2007-11-15
Last Update Date:2007-11-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC11325225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist