Provider Demographics
NPI:1558775528
Name:GOULDING, BRANDON (MSCPT)
Entity Type:Individual
Prefix:
First Name:BRANDON
Middle Name:
Last Name:GOULDING
Suffix:
Gender:M
Credentials:MSCPT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:152 E 118TH ST
Mailing Address - Street 2:
Mailing Address - City:NEW YORK
Mailing Address - State:NY
Mailing Address - Zip Code:10035-4087
Mailing Address - Country:US
Mailing Address - Phone:212-987-6500
Mailing Address - Fax:212-987-6505
Practice Address - Street 1:152 E 118TH ST
Practice Address - Street 2:TRIUMPH PHYSICAL THERAPY
Practice Address - City:NEW YORK
Practice Address - State:NY
Practice Address - Zip Code:10035-4087
Practice Address - Country:US
Practice Address - Phone:212-987-6500
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2014-06-17
Last Update Date:2020-05-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY037174225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY04541975Medicaid
13767497OtherCAQH
NY04541975Medicaid