Provider Demographics
NPI:1669981700
Name:LAW-GODAT, SUSAN JEANNE (PT, DPT)
Entity type:Individual
Prefix:
First Name:SUSAN
Middle Name:JEANNE
Last Name:LAW-GODAT
Suffix:
Gender:F
Credentials:PT, DPT
Other - Prefix:
Other - First Name:SUSAN
Other - Middle Name:JEANNE
Other - Last Name:LAW
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:2916 MONTEREY AVE SE
Mailing Address - Street 2:
Mailing Address - City:ALBUQUERQUE
Mailing Address - State:NM
Mailing Address - Zip Code:87106-2943
Mailing Address - Country:US
Mailing Address - Phone:503-358-9083
Mailing Address - Fax:
Practice Address - Street 1:4701 MONTGOMERY BLVD NE
Practice Address - Street 2:
Practice Address - City:ALBUQUERQUE
Practice Address - State:NM
Practice Address - Zip Code:87109-1219
Practice Address - Country:US
Practice Address - Phone:505-727-4628
Practice Address - Fax:503-358-9083
Is Sole Proprietor?:No
Enumeration Date:2017-09-20
Last Update Date:2017-09-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NM5104225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist
Provider Identifiers
StateIdentifier IDID TypeIssuer
NM5104OtherSTATE LICENSE