Provider Demographics
NPI:1306923420
Name:GODBOUT, CYNTHIA WINSLOW (RPT)
Entity type:Individual
Prefix:MRS
First Name:CYNTHIA
Middle Name:WINSLOW
Last Name:GODBOUT
Suffix:
Gender:F
Credentials:RPT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4 DENKERS DRIVE
Mailing Address - Street 2:
Mailing Address - City:BALLSTON LAKE
Mailing Address - State:NY
Mailing Address - Zip Code:12019
Mailing Address - Country:US
Mailing Address - Phone:518-877-5083
Mailing Address - Fax:
Practice Address - Street 1:121 OPPORTUNITY DRIVE
Practice Address - Street 2:
Practice Address - City:SCHOHARIE
Practice Address - State:NY
Practice Address - Zip Code:12157
Practice Address - Country:US
Practice Address - Phone:518-295-8130
Practice Address - Fax:518-295-8969
Is Sole Proprietor?:No
Enumeration Date:2006-11-01
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY0048651225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist