Healthcare Provider Details

I. General information

NPI: 1831485903
Provider Name (Legal Business Name): DOUGLAS JOHN GOLDSTEIN DPT
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 06/27/2011
Last Update Date: 01/07/2014
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

5801 S QUEBEC ST SUITE 100
GREENWOOD VILLAGE CO
80111-2003
US

IV. Provider business mailing address

7310 S ALTON WAY #6L
CENTENNIAL CO
80112-2334
US

V. Phone/Fax

Practice location:
  • Phone: 303-770-0870
  • Fax: 303-770-0871
Mailing address:
  • Phone: 303-790-4495
  • Fax: 720-488-1988

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code225100000X
TaxonomyPhysical Therapist
License Number11266
License Number StateCO

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: