Alex Charles Godderidge, DPT

Primary specialty

Physical TherapistTaxonomy code 225100000X

License

PT-7679 Issued in ID

Practice address

12072 W McMillan Rd
Boise, ID 83713-2462

Phone

(208) 939-0533

Fax

(208) 939-3341

NPI assigned

Jan 12, 2022

Last updated

Dec 1, 2023By the provider in NPPES

Sex

Male

Sole proprietor

No

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

Specialties & licenses 1

Addresses

Other identifiers 1

Medicare fee-for-service enrollment

Enrolled in ID

Enrollment records 1

Specialty

Physical Therapist in Private Practice

Education

Other, 2021

Medicare assignment

Accepts the Medicare-approved amount as payment in full

Group practices

ZRJ IncGroup PAC ID 6507858172, 12 clinicians

Practice addresses (Care Compare)

Medicare enrollment (NPD)

Enrolled

Practice roles

Locations

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

• ZRJ Inc

  dba Idaho Spine & Sports Physical Therapy

  • Physical Therapist
  • Boise, ID
  • NPI 1639365323
  Medicare reassignment Care Compare group NPD

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

{
    "created_epoch": "1641945600000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1701388800000",
    "number": "1942951736",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "119 S. VALLEY DR. STE A #178",
            "city": "NAMPA",
            "state": "ID",
            "postal_code": "83686",
            "telephone_number": "208-800-1619"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "12072 W MCMILLAN RD",
            "city": "BOISE",
            "state": "ID",
            "postal_code": "837132462",
            "telephone_number": "208-939-0533",
            "fax_number": "208-939-3341"
        }
    ],
    "practiceLocations": [
        {
            "address_1": "2175 N Whitley Dr",
            "address_purpose": "LOCATION",
            "city": "Fruitland",
            "state": "ID",
            "postal_code": "836192132",
            "country_code": "US",
            "telephone_number": "208-452-7197",
            "fax_number": "208-452-4811",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "basic": {
        "last_name": "GODDERIDGE",
        "first_name": "ALEX",
        "middle_name": "CHARLES",
        "credential": "DPT",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2022-01-12",
        "last_updated": "2023-12-01",
        "certification_date": "2023-12-01",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "225100000X",
            "taxonomy_group": "",
            "desc": "Physical Therapist",
            "state": "ID",
            "license": "PT-7679",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "STATE LICENSE",
            "identifier": "PT-7679",
            "state": "ID"
        }
    ],
    "endpoints": [],
    "other_names": []
}

• Traci Lynn Glover, LPC, LSW
• Christopher Gnadinger, MD
• Mary Gobeille, PHARMD
• Reginald Joseph Gobel, M.D.
• Christopher Skip Goddard, LPC
• Ben H. Godfrey, MD
• Nozomi Godfrey
• Hillary Godsill, LCSW
• John P Goeddertz, CRNA
• Jodi Goettemoeller, LCPC

• Physical Therapist in Boise, ID
• Providers in Boise, ID by specialty
• Physical Therapist in Idaho

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Dec 1, 2023; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments.
• Medicare Care Compare (CMS): clinician profile, group practices, facility affiliations, MIPS scores and star ratings.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.