MEDICARE: MRS. MAANGELICA GOODSTEIN P.T, DPT, PA-C

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	2497	NV
2	363A00000X	Physician Assistant	1227	NV

General Provider Information

NPI Number	:	1295944437
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MRS. MAANGELICA GOODSTEIN P.T, DPT, PA-C

Provider Business Mailing Address
First Line	:	720 PEACHY CANYON CIR UNIT 103
Second Line	:
City	:	LAS VEGAS
State	:	NV
Zip	:	89144-0894
Country	:	US
Telephone Number	:	702-758-4110
Fax Number	:

Provider Business Practice Location Address
First Line	:	3900 PARADISE RD STE V
Second Line	:
City	:	LAS VEGAS
State	:	NV
Zip	:	89169-0930
Country	:	US
Telephone Number	:	702-369-0560
Fax Number	:

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

Provider Enumeration Date	:	05/22/2007
Last Update Date	:	02/24/2020

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