Provider Demographics
NPI:1487290821
Name:BYNUM, ELIZABETH (PT, DPT)
Entity type:Individual
Prefix:
First Name:ELIZABETH
Middle Name:
Last Name:BYNUM
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 1:1 LAURA CT
Mailing Address - Street 2:
Mailing Address - City:CORTLANDT MANOR
Mailing Address - State:NY
Mailing Address - Zip Code:10567-7017
Mailing Address - Country:US
Mailing Address - Phone:914-736-1011
Mailing Address - Fax:
Practice Address - Street 1:1611 ROUTE 6
Practice Address - Street 2:
Practice Address - City:CARMEL
Practice Address - State:NY
Practice Address - Zip Code:10512-1933
Practice Address - Country:US
Practice Address - Phone:845-225-2000
Practice Address - Fax:845-225-5600
Is Sole Proprietor?:No
Enumeration Date:2019-11-20
Last Update Date:2019-11-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY045063225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist