Healthcare Provider Details

I. General information

NPI: 1255823050
Provider Name (Legal Business Name): JORDAN D GOLDSMITH MS, RD, LMNT
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 06/06/2018
Last Update Date: 06/06/2018
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

12565 W CENTER RD STE 100
OMAHA NE
68144-3810
US

IV. Provider business mailing address

12565 W CENTER RD STE 100
OMAHA NE
68144-3810
US

V. Phone/Fax

Practice location:
  • Phone: 402-342-5566
  • Fax: 402-342-0034
Mailing address:
  • Phone: 402-342-5566
  • Fax: 402-342-0034

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code225100000X
TaxonomyPhysical Therapist
License Number
License Number StateNE

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: