Basic Information
| Provider Information | |||||||||
| NPI: | 1083742613 | ||||||||
| EntityType: | 1 | ||||||||
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| LastName: | GODGES | ||||||||
| FirstName: | JOSEPH | ||||||||
| MiddleName: | JOHN | ||||||||
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| Credential: | D.P.T. | ||||||||
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| Mailing Information | |||||||||
| Address1: | 2109 MOUNT CALVARY RD | ||||||||
| Address2: | |||||||||
| City: | SANTA BARBARA | ||||||||
| State: | CA | ||||||||
| PostalCode: | 931052355 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 3103656470 | ||||||||
| FaxNumber: | 8666441472 | ||||||||
| Practice Location | |||||||||
| Address1: | 15200 W SUNSET BLVD | ||||||||
| Address2: | SUITE 111 | ||||||||
| City: | PACIFIC PALISADES | ||||||||
| State: | CA | ||||||||
| PostalCode: | 902723619 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 3105739340 | ||||||||
| FaxNumber: | 3105739328 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 03/02/2007 | ||||||||
| LastUpdateDate: | 02/07/2013 | ||||||||
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| ProviderGenderCode: | M | ||||||||
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| IsSoleProprietor: | N | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 2251X0800X | PT 12430 | CA | Y | Respiratory, Developmental, Rehabilitative and Restorative Service Providers | Physical Therapist | Orthopedic |
ID Information
| ID | Type | State | Issuer | Description | 0PT124300 | 01 | CA | BLUE SHIELD OF CALIFORNIA | OTHER |