Provider Demographics
NPI:1649498155
Name:GODFREY, MICHELE RENEE (MPT)
Entity type:Individual
Prefix:MRS
First Name:MICHELE
Middle Name:RENEE
Last Name:GODFREY
Suffix:
Gender:F
Credentials:MPT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 1764
Mailing Address - Street 2:
Mailing Address - City:MARTINSBURG
Mailing Address - State:WV
Mailing Address - Zip Code:25402-1764
Mailing Address - Country:US
Mailing Address - Phone:304-264-0036
Mailing Address - Fax:304-263-4123
Practice Address - Street 1:1516 WINCHESTER AVE
Practice Address - Street 2:
Practice Address - City:MARTINSBURG
Practice Address - State:WV
Practice Address - Zip Code:25401-5025
Practice Address - Country:US
Practice Address - Phone:304-263-5680
Practice Address - Fax:304-267-1532
Is Sole Proprietor?:Yes
Enumeration Date:2007-04-22
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WV002107225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist