Individual
KRISTIN GODIKSEN
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
P.T.
Contact information
Practice address
34 JEROME AVE, BLOOMFIELD, CT 06002-2463
(860) 519-1916
Mailing address
34 JEROME AVENUEE, SUITE # 305, BLOOMFIELD, CT 06002-3064
(860) 519-1916
Taxonomy
Speciality
Code
Description
License number
State
225100000X
Physical Therapist
Primary
002340
CT
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
002340
PHYSICAL THERAPY LICENSE
CT
Enumeration date
10/20/2006
Last updated
05/09/2014
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