Provider Demographics
NPI:1699726281
Name:GODBOLE, SWATI UDAY (LPT)
Entity type:Individual
Prefix:
First Name:SWATI
Middle Name:UDAY
Last Name:GODBOLE
Suffix:
Gender:F
Credentials:LPT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:103 NEW BOCA WAY
Mailing Address - Street 2:
Mailing Address - City:CARY
Mailing Address - State:NC
Mailing Address - Zip Code:27511-9559
Mailing Address - Country:US
Mailing Address - Phone:919-454-4578
Mailing Address - Fax:919-851-6740
Practice Address - Street 1:519 KEISLER DR
Practice Address - Street 2:
Practice Address - City:CARY
Practice Address - State:NC
Practice Address - Zip Code:27511-7098
Practice Address - Country:US
Practice Address - Phone:919-851-6740
Practice Address - Fax:919-851-6740
Is Sole Proprietor?:No
Enumeration Date:2006-05-16
Last Update Date:2010-07-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC5507225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist