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NPI Code Detail

MEDICARE: RICHARD M GOLDBACH PT

MEDICARE: RICHARD M GOLDBACH PT
Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

# Taxonomy Code Taxonomy License Number License Number State
1225100000XPhysical TherapistPT22081CA

General Provider Information

NPI Number : 1003848169
Entity Type Code : Individual
Provider Name (Legal Business Name) : RICHARD M GOLDBACH PT
Provider Business Mailing Address
First Line : 408 HIGUERA ST STE 200
Second Line :
City : SAN LUIS OBISPO
State : CA
Zip : 93401-6135
Country : US
Telephone Number : 805-788-0805
Fax Number : 805-788-0845
Provider Business Practice Location Address
First Line : 6907 EL CAMINO REAL STE D
Second Line :
City : ATASCADERO
State : CA
Zip : 93422-4386
Country : US
Telephone Number : 805-466-6719
Fax Number : 805-466-5286
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 07/07/2006
Last Update Date : 08/16/2023

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