Provider Demographics
NPI:1467561274
Name:GUNDLACH, PATRICIA LYNN (MS, ATC)
Entity Type:Individual
Prefix:MISS
First Name:PATRICIA
Middle Name:LYNN
Last Name:GUNDLACH
Suffix:
Gender:F
Credentials:MS, ATC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:44 MARION BLVD
Mailing Address - Street 2:
Mailing Address - City:SCOTIA
Mailing Address - State:NY
Mailing Address - Zip Code:12302-2602
Mailing Address - Country:US
Mailing Address - Phone:518-393-3334
Mailing Address - Fax:
Practice Address - Street 1:5030 STATE HIGHWAY 30
Practice Address - Street 2:
Practice Address - City:AMSTERDAM
Practice Address - State:NY
Practice Address - Zip Code:12010-7534
Practice Address - Country:US
Practice Address - Phone:518-841-3406
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2006-08-29
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY000358-12255A2300X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2255A2300XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersSpecialist/TechnologistAthletic Trainer