Provider Demographics
NPI:1386808889
Name:GODFREY, JASON P (DPT)
Entity type:Individual
Prefix:MR
First Name:JASON
Middle Name:P
Last Name:GODFREY
Suffix:
Gender:M
Credentials:DPT
Other - Prefix:
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Mailing Address - Street 1:15 SW EVERETT MALL WAY STE G
Mailing Address - Street 2:
Mailing Address - City:EVERETT
Mailing Address - State:WA
Mailing Address - Zip Code:98204-2715
Mailing Address - Country:US
Mailing Address - Phone:425-355-5222
Mailing Address - Fax:425-355-5231
Practice Address - Street 1:4915 25TH AVE NE STE 104
Practice Address - Street 2:
Practice Address - City:SEATTLE
Practice Address - State:WA
Practice Address - Zip Code:98105
Practice Address - Country:US
Practice Address - Phone:206-315-7998
Practice Address - Fax:206-316-2308
Is Sole Proprietor?:No
Enumeration Date:2008-07-14
Last Update Date:2020-01-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA34756225100000X
WAPT60844798225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist
Provider Identifiers
StateIdentifier IDID TypeIssuer
WA0392938OtherWA DEPT OF LNI