Provider Demographics
NPI:1114471398
Name:GOLDWYN & BOYLAND PHYSICAL THERAPY
Entity Type:Organization
Organization Name:GOLDWYN & BOYLAND PHYSICAL THERAPY
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PHYSICAL THERAPIST
Authorized Official - Prefix:MISS
Authorized Official - First Name:KELLY
Authorized Official - Middle Name:ANN
Authorized Official - Last Name:BRUNSCHEEN
Authorized Official - Suffix:
Authorized Official - Credentials:DPT
Authorized Official - Phone:607-756-9886
Mailing Address - Street 1:274 TOMPKINS ST
Mailing Address - Street 2:
Mailing Address - City:CORTLAND
Mailing Address - State:NY
Mailing Address - Zip Code:13045-3455
Mailing Address - Country:US
Mailing Address - Phone:607-756-9886
Mailing Address - Fax:607-756-8939
Practice Address - Street 1:274 TOMPKINS ST
Practice Address - Street 2:
Practice Address - City:CORTLAND
Practice Address - State:NY
Practice Address - Zip Code:13045-3455
Practice Address - Country:US
Practice Address - Phone:607-756-9886
Practice Address - Fax:607-756-8939
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2016-08-05
Last Update Date:2016-08-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY039195-1261QP2000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QP2000XAmbulatory Health Care FacilitiesClinic/CenterPhysical Therapy