Provider Demographics
NPI:1902982374
Name:STURGES, GWENDOLYN ANNE (PT)
Entity Type:Individual
Prefix:MS
First Name:GWENDOLYN
Middle Name:ANNE
Last Name:STURGES
Suffix:
Gender:F
Credentials:PT
Other - Prefix:MRS
Other - First Name:GWENDOLYN
Other - Middle Name:ANNE
Other - Last Name:MEYER
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:PO BOX 172
Mailing Address - Street 2:
Mailing Address - City:ELIZABETHTOWN
Mailing Address - State:NY
Mailing Address - Zip Code:12932-0172
Mailing Address - Country:US
Mailing Address - Phone:518-873-2059
Mailing Address - Fax:518-873-5814
Practice Address - Street 1:211 WATER ST
Practice Address - Street 2:
Practice Address - City:ELIZABETHTOWN
Practice Address - State:NY
Practice Address - Zip Code:12932-0172
Practice Address - Country:US
Practice Address - Phone:518-873-2059
Practice Address - Fax:518-873-5814
Is Sole Proprietor?:No
Enumeration Date:2006-10-28
Last Update Date:2013-08-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY009720225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist
Provider Identifiers
StateIdentifier IDID TypeIssuer
NYCC3817Medicare ID - Type Unspecified
P21160Medicare UPIN