Provider Demographics
NPI:1093862229
Name:GOYNIAS, JERRY IRA (PT)
Entity Type:Individual
Prefix:
First Name:JERRY
Middle Name:IRA
Last Name:GOYNIAS
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 1:405 RIDGECREST DR
Mailing Address - Street 2:
Mailing Address - City:CHAPEL HILL
Mailing Address - State:NC
Mailing Address - Zip Code:27514-2107
Mailing Address - Country:US
Mailing Address - Phone:919-932-3674
Mailing Address - Fax:
Practice Address - Street 1:405 RIDGECREST DR
Practice Address - Street 2:
Practice Address - City:CHAPEL HILL
Practice Address - State:NC
Practice Address - Zip Code:27514-2107
Practice Address - Country:US
Practice Address - Phone:919-932-3674
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2007-01-03
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC1344225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist