Provider Demographics
NPI:1891883203
Name:GOYN, DARRIN LEE (MPT)
Entity Type:Individual
Prefix:MR
First Name:DARRIN
Middle Name:LEE
Last Name:GOYN
Suffix:
Gender:M
Credentials:MPT
Other - Prefix:MRS
Other - First Name:SHELLY
Other - Middle Name:L
Other - Last Name:LAWS
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:
Mailing Address - Street 1:541A EAST FLAMING GORGE WAY
Mailing Address - Street 2:
Mailing Address - City:GREEN RIVER
Mailing Address - State:WY
Mailing Address - Zip Code:82935
Mailing Address - Country:US
Mailing Address - Phone:307-875-4654
Mailing Address - Fax:307-875-4741
Practice Address - Street 1:541A EAST FLAMING GORGE WAY
Practice Address - Street 2:
Practice Address - City:GREEN RIVER
Practice Address - State:WY
Practice Address - Zip Code:82935
Practice Address - Country:US
Practice Address - Phone:307-875-4654
Practice Address - Fax:307-875-4741
Is Sole Proprietor?:No
Enumeration Date:2006-10-11
Last Update Date:2007-12-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WYPT872225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist
Provider Identifiers
StateIdentifier IDID TypeIssuer
WY05913OtherBCBS
WY20756Medicare PIN
WY20755Medicare PIN