Healthcare Provider Details

I. General information

NPI: 1376261511
Provider Name (Legal Business Name): GILLIAN CORWIN DPT
Entity Type: Individual
Gender: Female
Sole Proprietor: N

Provider Other Name: GILLIAN LAMB DPT

II. Dates (important events)

Enumeration Date: 08/15/2022
Last Update Date: 12/07/2023
Certification Date: 12/07/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

60 FINN RD STE C
HENRIETTA NY
14467-9391
US

IV. Provider business mailing address

60 FINN RD STE C
HENRIETTA NY
14467-9391
US

V. Phone/Fax

Practice location:
  • Phone: 585-444-0040
  • Fax:
Mailing address:
  • Phone: 585-444-0040
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code225100000X
TaxonomyPhysical Therapist
License Number048958
License Number StateNY

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: