Healthcare Provider Details

I. General information

NPI: 1023933181
Provider Name (Legal Business Name): DANIEL GODINEZ PT, DPT
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 08/10/2026
Last Update Date: 08/19/2026
Certification Date: 08/19/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1750 WILCO RD
STAYTON OR
97383-1085
US

IV. Provider business mailing address

3400 STATE ST STE G780
SALEM OR
97301-7015
US

V. Phone/Fax

Practice location:
  • Phone: 503-769-7131
  • Fax: 503-769-7132
Mailing address:
  • Phone: 503-769-7131
  • Fax: 503-769-7132

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code225100000X
TaxonomyPhysical Therapist
License NumberCP061387T
License Number StateOR
# 2
Primary TaxonomyN
Taxonomy Code225100000X
TaxonomyPhysical Therapist
License Number1408819
License Number StateTX

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: