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General NPI Number Information
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NPI Number | 1689635732
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Entity Type | Individual
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Provider Name | ANDREW JOSEPH GODEK ATC, PT
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Gender | Male
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Dates
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Enumeration Date | 03/29/2006
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Last Update Date | 02/16/2018
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Provider Practice Location Address
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Address Line | 1348 SOUTH 18TH STREET BAPTIST REHAB
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City | FERNANDINA BEACH
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State | FL
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Zip | 32034
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Country | US
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Telephone | 904-321-3850
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Fax |
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Provider Business Mailing Address
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Address Line | 1348 S. 18TH STREET BAPTIST REHAB
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City | FERNANDINA BEACH
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State | FL
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Zip | 32034
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Country | US
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Telephone | 904-321-3850
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Fax |
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 2255A2300X
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Taxonomy Name | Athletic Trainer
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License Number | AL2080
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License Number State | FL
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Taxonomy #2
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Taxonomy Code | 225100000X
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Taxonomy Name | Physical Therapist
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License Number | PT26195
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License Number State | FL
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