Individual
ALEX CHARLES GODDERIDGE
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
DPT
Contact information
Practice address
12072 W MCMILLAN RD, BOISE, ID 83713-2462
(208) 939-0533
(208) 939-3341
Mailing address
119 S. VALLEY DR. STE A #178, NAMPA, ID 83686
(208) 800-1619
Taxonomy
Speciality
Code
Description
License number
State
225100000X
Physical Therapist
Primary
PT-7679
ID
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
PT-7679
STATE LICENSE
ID
Enumeration date
01/12/2022
Last updated
12/01/2023
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