Provider Demographics
NPI:1265740856
Name:GODINO, DAVID RAY (PT, DPT)
Entity type:Individual
Prefix:DR
First Name:DAVID
Middle Name:RAY
Last Name:GODINO
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 1:2525 N. GRANDVIEW AVENUE
Mailing Address - Street 2:SUITE 400
Mailing Address - City:ODESSA
Mailing Address - State:TX
Mailing Address - Zip Code:79761-4781
Mailing Address - Country:US
Mailing Address - Phone:432-550-4700
Mailing Address - Fax:432-550-4715
Practice Address - Street 1:2545 PERRYTON PKWY STE 35
Practice Address - Street 2:
Practice Address - City:PAMPA
Practice Address - State:TX
Practice Address - Zip Code:79065-2820
Practice Address - Country:US
Practice Address - Phone:806-486-1697
Practice Address - Fax:806-412-5573
Is Sole Proprietor?:No
Enumeration Date:2010-09-17
Last Update Date:2017-08-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX12003002251X0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2251X0800XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical TherapistOrthopedic
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX2833224802Medicaid
TX1200300OtherECPTOTE
TX1200300OtherECPTOTE