Provider Demographics
NPI:1376690800
Name:GODFREY, SARAJANE D (PT)
Entity Type:Individual
Prefix:
First Name:SARAJANE
Middle Name:D
Last Name:GODFREY
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:WYOMING COUNTY COMMUNITY HOSPITAL
Mailing Address - Street 2:400 NORTH MAIN ST
Mailing Address - City:WARSAW
Mailing Address - State:NY
Mailing Address - Zip Code:14569
Mailing Address - Country:US
Mailing Address - Phone:585-786-8940
Mailing Address - Fax:585-786-1275
Practice Address - Street 1:WYOMING COUNTY COMMUNITY HOSPITAL
Practice Address - Street 2:400 NORTH MAIN ST
Practice Address - City:WARSAW
Practice Address - State:NY
Practice Address - Zip Code:14569
Practice Address - Country:US
Practice Address - Phone:585-786-8940
Practice Address - Fax:585-786-1275
Is Sole Proprietor?:No
Enumeration Date:2007-01-05
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY021559-1225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist