Provider Demographics
NPI:1871173658
Name:GODEAUX, AMAINTE B
Entity type:Individual
Prefix:
First Name:AMAINTE
Middle Name:B
Last Name:GODEAUX
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:615 EASY ROCK LANDING DR
Mailing Address - Street 2:
Mailing Address - City:BROUSSARD
Mailing Address - State:LA
Mailing Address - Zip Code:70518-7775
Mailing Address - Country:US
Mailing Address - Phone:337-945-0631
Mailing Address - Fax:
Practice Address - Street 1:1007 BERTRAND PKWY
Practice Address - Street 2:
Practice Address - City:BROUSSARD
Practice Address - State:LA
Practice Address - Zip Code:70518-8025
Practice Address - Country:US
Practice Address - Phone:337-945-0631
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2021-04-14
Last Update Date:2021-04-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes225500000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersSpecialist/TechnologistGroup - Single Specialty