Provider Demographics
NPI:1659576296
Name:GOLDWYN & BOYLAND PHYSICAL THERAPY PC
Entity Type:Organization
Organization Name:GOLDWYN & BOYLAND PHYSICAL THERAPY PC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:MR
Authorized Official - First Name:DAVID
Authorized Official - Middle Name:A
Authorized Official - Last Name:BOYLAND
Authorized Official - Suffix:
Authorized Official - Credentials:PT
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:2007-06-15
Last Update Date:2014-07-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY011326-1225100000X
NY004432-1225X00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical TherapistGroup - Single Specialty
No225X00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational TherapistGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY02140256Medicaid
NYS88701Medicare UPIN