Basic Information
Provider Information
NPI: 1811917719
EntityType: 1
ReplacementNPI:  
OrganizationName:  
LastName: GOLLNER
FirstName: HELEN
MiddleName:  
NamePrefix:  
NameSuffix:  
Credential: PT
OtherOrganizationName:  
OtherOrganizationType:  
OtherLastName:  
OtherFirstName:  
OtherMiddleName:  
OtherNamePrefix:  
OtherNameSuffix:  
OtherCredential:  
OtherLastNameType:  
Mailing Information
Address1: SLEEPY HOLLOW PHYSICAL THERAPY
Address2: 24 SAW MILL RIVER ROAD, SUITE 204
City: HAWTHORNE
State: NY
PostalCode: 10532
CountryCode: US
TelephoneNumber: 9146316969
FaxNumber:  
Practice Location
Address1: SLEEPY HOLLOW PHYSICAL THERAPY
Address2: 24 SAW MILL RIVER ROAD, SUITE 204
City: HAWTHORNE
State: NY
PostalCode: 10532
CountryCode: US
TelephoneNumber: 9146316969
FaxNumber:  
Other Information
ProviderEnumerationDate: 07/20/2006
LastUpdateDate: 07/08/2007
NPIDeactivationReasonCode:  
NPIDeactivationDate:  
NPIReactivationDate:  
ProviderGenderCode: F
AuthorizedOfficialLastName:  
AuthorizedOfficialFirstName:  
AuthorizedOfficialMiddleName:  
AuthorizedOfficialTitleorPosition:  
AuthorizedOfficialTelephone:  
IsSoleProprietor: N
IsOrganizationSubpart:  
ParentOrganizationLBN:  
AuthorizedOfficialNamePrefix:  
AuthorizedOfficialNameSuffix:  
AuthorizedOfficialCredential:  
NPICertificationDate:  

Taxonomy Information
TaxonomyLicenseStateSwitchTaxonomyGroupTaxonomyTypeTaxonomyClassSubSpecialty
2251X0800X004903NYY Respiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical TherapistOrthopedic

No ID Information.


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