Provider Demographics
NPI:1063503415
Name:GOLDWYN, JOAN C (PT)
Entity Type:Individual
Prefix:MRS
First Name:JOAN
Middle Name:C
Last Name:GOLDWYN
Suffix:
Gender:F
Credentials:PT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:274 TOMPKINS STREET
Mailing Address - Street 2:
Mailing Address - City:CORTLAND
Mailing Address - State:NY
Mailing Address - Zip Code:13045
Mailing Address - Country:US
Mailing Address - Phone:607-756-9886
Mailing Address - Fax:607-756-8939
Practice Address - Street 1:274 TOMPKINS STREET
Practice Address - Street 2:
Practice Address - City:CORTLAND
Practice Address - State:NY
Practice Address - Zip Code:13045
Practice Address - Country:US
Practice Address - Phone:607-756-9886
Practice Address - Fax:607-756-8939
Is Sole Proprietor?:No
Enumeration Date:2006-09-28
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY0024541225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY002454OtherBCBS FOR ALL BCBS
NY002454OtherHMO IN NETWORK PROVIDER
NY00750147Medicaid
NY002454OtherBCBS FOR ALL BCBS
NY00750147Medicaid