MEDICARE: KATHRYN L GOLDBERG PT, DPT

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	PT30693	FL

General Provider Information

NPI Number	:	1124494141
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	KATHRYN L GOLDBERG PT, DPT

Provider Business Mailing Address
First Line	:	15751 SAN CARLOS BLVD
Second Line	:	SUITE 4
City	:	FORT MYERS
State	:	FL
Zip	:	33908-3314
Country	:	US
Telephone Number	:	239-337-2739
Fax Number	:

Provider Business Practice Location Address
First Line	:	15751 SAN CARLOS BLVD
Second Line	:	SUITE 4
City	:	FORT MYERS
State	:	FL
Zip	:	33908-3314
Country	:	US
Telephone Number	:	239-337-2739
Fax Number	:

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

Provider Enumeration Date	:	08/13/2015
Last Update Date	:	08/13/2015

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