Provider Demographics
NPI:1386708956
Name:GUSHLAW, JOSEFA S (PT, DPT)
Entity type:Individual
Prefix:MRS
First Name:JOSEFA
Middle Name:S
Last Name:GUSHLAW
Suffix:
Gender:F
Credentials:PT, DPT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:14 GARFIELD RD
Mailing Address - Street 2:P.O. BOX 547
Mailing Address - City:POTSDAM
Mailing Address - State:NY
Mailing Address - Zip Code:13676-3480
Mailing Address - Country:US
Mailing Address - Phone:315-265-7917
Mailing Address - Fax:315-265-5437
Practice Address - Street 1:14 GARFIELD RD
Practice Address - Street 2:
Practice Address - City:POTSDAM
Practice Address - State:NY
Practice Address - Zip Code:13676-3480
Practice Address - Country:US
Practice Address - Phone:315-265-7917
Practice Address - Fax:315-265-5437
Is Sole Proprietor?:No
Enumeration Date:2006-12-20
Last Update Date:2008-06-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY021008-1225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist
Provider Identifiers
StateIdentifier IDID TypeIssuer
NYRA4004Medicare PIN