Provider Demographics
NPI:1366227076
Name:GOLLINGE, KATHRYN VICTORIA
Entity type:Individual
Prefix:
First Name:KATHRYN
Middle Name:VICTORIA
Last Name:GOLLINGE
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:224 KINGSLEY AVE
Mailing Address - Street 2:
Mailing Address - City:STATEN ISLAND
Mailing Address - State:NY
Mailing Address - Zip Code:10314-2305
Mailing Address - Country:US
Mailing Address - Phone:347-819-2714
Mailing Address - Fax:
Practice Address - Street 1:112 W 34TH ST
Practice Address - Street 2:
Practice Address - City:NEW YORK
Practice Address - State:NY
Practice Address - Zip Code:10120-0101
Practice Address - Country:US
Practice Address - Phone:212-502-7063
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2023-08-30
Last Update Date:2023-08-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY050918225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist