Provider Demographics
NPI:1104037910
Name:GODWIN, ELLEN M (PT, PHD, PCS)
Entity Type:Individual
Prefix:
First Name:ELLEN
Middle Name:M
Last Name:GODWIN
Suffix:
Gender:F
Credentials:PT, PHD, PCS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:302 96TH ST
Mailing Address - Street 2:APT 1-A
Mailing Address - City:BROOKLYN
Mailing Address - State:NY
Mailing Address - Zip Code:11209-7852
Mailing Address - Country:US
Mailing Address - Phone:718-745-4722
Mailing Address - Fax:
Practice Address - Street 1:445 LENOX RD
Practice Address - Street 2:BOX 30
Practice Address - City:BROOKLYN
Practice Address - State:NY
Practice Address - Zip Code:11203-2017
Practice Address - Country:US
Practice Address - Phone:718-270-2811
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2007-05-24
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY0072232251P0200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2251P0200XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical TherapistPediatrics