Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 2251P0200X | Physical Therapist - Pediatrics | 007223 | NY |
NPI | 1104037910 |
---|---|
Provider Name | Ellen M Godwin |
First Address | Brooklyn, NY 11209-7852 |
Second Address | Brooklyn, NY 11203-2017 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 24/05/2007 |
Last Update Date | 08/07/2007 |