Provider Demographics
NPI:1063652634
Name:GUGERTY, PAUL T (PT)
Entity Type:Individual
Prefix:
First Name:PAUL
Middle Name:T
Last Name:GUGERTY
Suffix:
Gender:M
Credentials:PT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:660 HUNTER LN
Mailing Address - Street 2:
Mailing Address - City:CORTLAND
Mailing Address - State:NY
Mailing Address - Zip Code:13045-8140
Mailing Address - Country:US
Mailing Address - Phone:607-753-1165
Mailing Address - Fax:
Practice Address - Street 1:660 HUNTER LN
Practice Address - Street 2:
Practice Address - City:CORTLAND
Practice Address - State:NY
Practice Address - Zip Code:13045-8140
Practice Address - Country:US
Practice Address - Phone:607-753-1165
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2009-02-23
Last Update Date:2012-02-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY014513-1225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist