Healthcare Provider Details

I. General information

NPI: 1821651738
Provider Name (Legal Business Name): PATRICIA GOLDBERG PT, DPT
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 04/16/2019
Last Update Date: 12/22/2021
Certification Date: 12/22/2021
Deactivation Date: 09/25/2020
Reactivation Date: 10/07/2020

III. Provider practice location address

8348 TRAFORD LN STE 100
WEST SPRINGFIELD VA
22152-1650
US

IV. Provider business mailing address

200 1ST ST SW
ROCHESTER MN
55905-0001
US

V. Phone/Fax

Practice location:
  • Phone: 703-569-7335
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code225100000X
TaxonomyPhysical Therapist
License Number2305213919
License Number StateVA
# 2
Primary TaxonomyY
Taxonomy Code225100000X
TaxonomyPhysical Therapist
License Number12084
License Number StateMN

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: