Individual provider Active NPI

Nikita Godbole, DPT

  • Physical Therapist
  • Decatur, GA
National Provider Identifier
1376190264
Registry record updated Aug 25, 2019
On this page

Key facts

NPPES NPI Registry
Primary specialty
Physical TherapistTaxonomy code 225100000X
License
PT014095 Issued in GA
Practice address
505 Irvin CT Ste 101
Decatur, GA 30030-1780
Phone
(404) 297-0821
NPI assigned
Aug 25, 2019
Sex
Female
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on Aug 25, 2019

Registry information is reported by the provider to CMS and is not verified. About this source

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Physical Therapist 225100000X PT014095 GA Primary

Addresses

Primary practice location

505 Irvin CT Ste 101
Decatur, GA 30030-1780

Mailing address

103 New Boca Way
Cary, NC 27518-9559
Phone (919) 961-0422

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in GA

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
I20230918001981 GA Practitioner - Physical Therapist in Private Practice 6305200817 Reassigns benefits to 1 organization

National Provider Directory

National Provider Directory
Medicare enrollment (NPD)
Enrolled

Practice roles

OrganizationSpecialtyStatusNew patients
Esop Rehabilitation, LLC Physical Therapist CurrentSince Sep 15, 2023 Accepting new patients
Esop Rehabilitation, LLC Physical Therapist CurrentSince Sep 15, 2023 Accepting new patients
Esop Rehabilitation LLC Physical Therapist Current Accepting new patients

Locations

875 Flat Shoals Rd SE
Ste 150
Conyers, GA 30094
Phone (770) 785-7669

505 Irvin Ct
Ste 101
Decatur, GA 30030
Phone (404) 297-0821

199 Medical Blvd
Stockbridge, GA 30281
Phone (404) 735-8212

Organizations & group practices 3

Organizations this provider is connected to: Medicare benefit reassignments (the organization bills Medicare for this provider’s services), Care Compare group memberships and National Provider Directory roles.

NPI Registry JSON

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1566691200000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1566691200000",
    "number": "1376190264",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "103 NEW BOCA WAY",
            "city": "CARY",
            "state": "NC",
            "postal_code": "275189559",
            "telephone_number": "919-961-0422"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "505 IRVIN CT STE 101",
            "city": "DECATUR",
            "state": "GA",
            "postal_code": "300301780",
            "telephone_number": "404-297-0821"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "GODBOLE",
        "first_name": "NIKITA",
        "credential": "DPT",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2019-08-25",
        "last_updated": "2019-08-25",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "225100000X",
            "taxonomy_group": "",
            "desc": "Physical Therapist",
            "state": "GA",
            "license": "PT014095",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Decatur, GA

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Aug 25, 2019; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
  • Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments.
  • National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.