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General NPI Number Information
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NPI Number | 1891106316
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Entity Type | Individual
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Provider Name | BREANNA GODFREY PT, DPT
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Gender | Female
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Dates
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Enumeration Date | 05/19/2014
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Last Update Date | 05/19/2014
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Provider Practice Location Address
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Address Line | 720 E BROAD ST
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City | COLUMBUS
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State | OH
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Zip | 43215-3988
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Country | US
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Telephone | 614-224-1090
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Fax |
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Provider Business Mailing Address
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Address Line | 5695 ROCKEFELLER CENTER BLVD
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City | DUBLIN
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State | OH
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Zip | 43016-7134
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Country | US
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Telephone | 440-567-8540
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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 | 225100000X
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Taxonomy Name | Physical Therapist
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License Number | 014734
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License Number State | OH
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