MEDICARE: SHARON O'DONNELL GOLDBERG PT

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	225100000X	Physical Therapist	1041804	TX

General Provider Information

NPI Number	:	1043596539
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	SHARON O'DONNELL GOLDBERG PT

Provider Business Mailing Address
First Line	:	6116 OAKBEND TRL
Second Line	:	STE 100
City	:	FT WORTH
State	:	TX
Zip	:	76132-3925
Country	:	US
Telephone Number	:	817-336-8293
Fax Number	:	817-336-9017

Provider Business Practice Location Address
First Line	:	6116 OAKBEND TRL
Second Line	:	STE 100
City	:	FT WORTH
State	:	TX
Zip	:	76132-3925
Country	:	US
Telephone Number	:	817-336-8293
Fax Number	:	817-336-9017

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	10/27/2011
Last Update Date	:	02/14/2012

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