Basic Information
| Provider Information | |||||||||
| NPI: | 1598074908 | ||||||||
| EntityType: | 1 | ||||||||
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| OrganizationName: | |||||||||
| LastName: | GODIN | ||||||||
| FirstName: | BENJAMIN | ||||||||
| MiddleName: | D | ||||||||
| NamePrefix: | DR. | ||||||||
| NameSuffix: | |||||||||
| Credential: | PT, DPT | ||||||||
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| Mailing Information | |||||||||
| Address1: | 1519 CENTRAL ST | ||||||||
| Address2: | |||||||||
| City: | STOUGHTON | ||||||||
| State: | MA | ||||||||
| PostalCode: | 020724415 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 7812970979 | ||||||||
| FaxNumber: | 7812973703 | ||||||||
| Practice Location | |||||||||
| Address1: | 97 GREEN ST | ||||||||
| Address2: | 2ND FLOOR | ||||||||
| City: | FOXBORO | ||||||||
| State: | MA | ||||||||
| PostalCode: | 020352865 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 7742155401 | ||||||||
| FaxNumber: | 7742150029 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 10/03/2010 | ||||||||
| LastUpdateDate: | 02/03/2014 | ||||||||
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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 | 225100000X | 19296 | MA | Y | Respiratory, Developmental, Rehabilitative and Restorative Service Providers | Physical Therapist |
No ID Information.