Provider Demographics
NPI:1891844072
Name:GODSON, SUSAN C (PT, OCS)
Entity Type:Individual
Prefix:MS
First Name:SUSAN
Middle Name:C
Last Name:GODSON
Suffix:
Gender:F
Credentials:PT, OCS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:7155 ATASCOCITA RD
Mailing Address - Street 2:
Mailing Address - City:HUMBLE
Mailing Address - State:TX
Mailing Address - Zip Code:77346-5014
Mailing Address - Country:US
Mailing Address - Phone:281-812-8304
Mailing Address - Fax:281-812-8306
Practice Address - Street 1:7155 ATASCOCITA RD
Practice Address - Street 2:
Practice Address - City:HUMBLE
Practice Address - State:TX
Practice Address - Zip Code:77346-5014
Practice Address - Country:US
Practice Address - Phone:281-812-8304
Practice Address - Fax:281-812-8306
Is Sole Proprietor?:No
Enumeration Date:2007-01-09
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX1167358225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX1167358OtherTX STATE LICENSE NUMBER
AZ60238Medicare ID - Type UnspecifiedMCR PROVIDER NUMBER
TX1167358OtherTX STATE LICENSE NUMBER