Provider Demographics
NPI:1851990865
Name:GODDARD, ANDRIA (LMT)
Entity Type:Individual
Prefix:
First Name:ANDRIA
Middle Name:
Last Name:GODDARD
Suffix:
Gender:F
Credentials:LMT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:570 KELLEY BLVD.
Mailing Address - Street 2:UNIT 2B
Mailing Address - City:NORTH ATTLEBORO
Mailing Address - State:MA
Mailing Address - Zip Code:02760
Mailing Address - Country:US
Mailing Address - Phone:508-507-9559
Mailing Address - Fax:
Practice Address - Street 1:570 KELLEY BLVD.
Practice Address - Street 2:UNIT 2B
Practice Address - City:NORTH ATTLEBORO
Practice Address - State:MA
Practice Address - Zip Code:02760
Practice Address - Country:US
Practice Address - Phone:508-507-9559
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2020-10-21
Last Update Date:2020-10-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MA4044225700000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225700000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersMassage Therapist