Provider Demographics
NPI:1942550587
Name:GODIN, TERRA (DPT)
Entity Type:Individual
Prefix:DR
First Name:TERRA
Middle Name:
Last Name:GODIN
Suffix:
Gender:F
Credentials:DPT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1096 COUNTY ROUTE 20
Mailing Address - Street 2:
Mailing Address - City:CONSTABLE
Mailing Address - State:NY
Mailing Address - Zip Code:12926-3602
Mailing Address - Country:US
Mailing Address - Phone:315-244-3453
Mailing Address - Fax:
Practice Address - Street 1:1096 COUNTY ROUTE 20
Practice Address - Street 2:
Practice Address - City:CONSTABLE
Practice Address - State:NY
Practice Address - Zip Code:12926-3602
Practice Address - Country:US
Practice Address - Phone:315-244-3453
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2012-09-11
Last Update Date:2012-09-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CT009207225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist