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General NPI Number Information
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NPI Number | 1821487638
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Entity Type | Individual
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Provider Name | TERESA GODOY PTA
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Gender | Female
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Dates
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Enumeration Date | 01/16/2015
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Last Update Date | 01/22/2015
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Provider Practice Location Address
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Address Line | 5310 FOUNTAIN AVE FOUNTAIN VIEW SUBACUTE & NURSING,
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City | LOS ANGELES
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State | CA
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Zip | 90029
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Country | US
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Telephone | 323-461-9961
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Fax | 323-461-6854
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Provider Business Mailing Address
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Address Line | 415 E DRYDEN ST UNIT 101
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City | GLENDALE
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State | CA
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Zip | 91207-2251
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Country | US
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Telephone |
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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 | 225200000X
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Taxonomy Name | Physical Therapy Assistant
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License Number | AT 6490
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License Number State | CA
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