Provider Demographics
NPI:1174775464
Name:GODBY, NICHOLAS
Entity type:Individual
Prefix:
First Name:NICHOLAS
Middle Name:
Last Name:GODBY
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:9250 BLUE ASH RD
Mailing Address - Street 2:
Mailing Address - City:BLUE ASH
Mailing Address - State:OH
Mailing Address - Zip Code:45242-6822
Mailing Address - Country:US
Mailing Address - Phone:513-792-7441
Mailing Address - Fax:513-791-4042
Practice Address - Street 1:9250 BLUE ASH RD
Practice Address - Street 2:
Practice Address - City:BLUE ASH
Practice Address - State:OH
Practice Address - Zip Code:45242-6822
Practice Address - Country:US
Practice Address - Phone:513-792-7441
Practice Address - Fax:513-791-4042
Is Sole Proprietor?:No
Enumeration Date:2008-10-17
Last Update Date:2023-03-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH35.094823208100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208100000XAllopathic & Osteopathic PhysiciansPhysical Medicine & Rehabilitation