Provider Demographics
NPI:1629361415
Name:GOUDREAU, CHRISTINE E (PTA)
Entity type:Individual
Prefix:MRS
First Name:CHRISTINE
Middle Name:E
Last Name:GOUDREAU
Suffix:
Gender:F
Credentials:PTA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:15 SUFFERN PL STE A
Mailing Address - Street 2:
Mailing Address - City:SUFFERN
Mailing Address - State:NY
Mailing Address - Zip Code:10901-5566
Mailing Address - Country:US
Mailing Address - Phone:845-357-4500
Mailing Address - Fax:
Practice Address - Street 1:150 PIKE ST
Practice Address - Street 2:
Practice Address - City:PORT JERVIS
Practice Address - State:NY
Practice Address - Zip Code:12771-1867
Practice Address - Country:US
Practice Address - Phone:845-800-5974
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2011-05-26
Last Update Date:2025-11-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY645798-01163W00000X
NY003470-1225200000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes163W00000XNursing Service ProvidersRegistered NurseGroup - Single Specialty
No225200000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapy Assistant