Healthcare Provider Details

I. General information

NPI: 1346311966
Provider Name (Legal Business Name): DAVID A GOLDBERG PT
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 11/13/2006
Last Update Date: 03/08/2016
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1900 LAFAYETTE RD STE C
PORTSMOUTH NH
03801-5679
US

IV. Provider business mailing address

1900 LAFAYETTE RD STE C
PORTSMOUTH NH
03801-5679
US

V. Phone/Fax

Practice location:
  • Phone: 603-431-5600
  • Fax: 603-431-5610
Mailing address:
  • Phone: 603-431-5600
  • Fax: 603-431-5610

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code225100000X
TaxonomyPhysical Therapist
License Number2934
License Number StateNH

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: