Provider Demographics
NPI:1518365394
Name:GODSEY, DANA (PTA)
Entity type:Individual
Prefix:MRS
First Name:DANA
Middle Name:
Last Name:GODSEY
Suffix:
Gender:F
Credentials:PTA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:10739 CHESTNUT HILL RD
Mailing Address - Street 2:
Mailing Address - City:CRAB ORCHARD
Mailing Address - State:TN
Mailing Address - Zip Code:37723-1510
Mailing Address - Country:US
Mailing Address - Phone:931-200-8103
Mailing Address - Fax:
Practice Address - Street 1:444 ONE ELEVEN PL
Practice Address - Street 2:
Practice Address - City:COOKEVILLE
Practice Address - State:TN
Practice Address - Zip Code:38506-4358
Practice Address - Country:US
Practice Address - Phone:931-525-6655
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2014-12-10
Last Update Date:2014-12-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TNPTA0000002683225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist