Healthcare Provider Details

I. General information

NPI: 1699144956
Provider Name (Legal Business Name): AMANDA GOLDSTEIN DPT
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 09/16/2015
Last Update Date: 09/16/2015
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

790 COLLEGE PKWY FANNY ALLEN CAMPUS
COLCHESTER VT
05446-3007
US

IV. Provider business mailing address

60 NORTH ST
WINOOSKI VT
05404-1305
US

V. Phone/Fax

Practice location:
  • Phone: 802-847-1902
  • Fax:
Mailing address:
  • Phone: 802-497-4454
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code225100000X
TaxonomyPhysical Therapist
License Number040.0103932
License Number StateVT

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: