Healthcare Provider Details

I. General information

NPI: 1720197304
Provider Name (Legal Business Name): JONATHAN GOLDBERG PT
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 08/29/2006
Last Update Date: 07/08/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

572 E MCNAB RD
POMPANO BEACH FL
33060-9355
US

IV. Provider business mailing address

6245 N FEDERAL HWY SUITE 300
FORT LAUDERDALE FL
33308-1998
US

V. Phone/Fax

Practice location:
  • Phone: 954-738-1709
  • Fax: 954-738-1699
Mailing address:
  • Phone: 954-956-1966
  • Fax: 954-745-0501

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code225100000X
TaxonomyPhysical Therapist
License NumberPT18039
License Number StateFL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: