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NPI Code Detail

MEDICARE: MR. GREGORY GOLDBLATT MPT, PT

MEDICARE: MR. GREGORY GOLDBLATT MPT, 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
12251G0304XGeriatric Physical Therapist1592NM
22251G0304XGeriatric Physical TherapistPT1592NM

General Provider Information

NPI Number : 1790780385
Entity Type Code : Individual
Provider Name (Legal Business Name) : MR. GREGORY GOLDBLATT MPT, PT
Provider Business Mailing Address
First Line : 301 PERKINS DR.
Second Line : STE C
City : LAS CRUCES
State : NM
Zip : 88005-3248
Country : US
Telephone Number : 575-523-7243
Fax Number : 575-525-5641
Provider Business Practice Location Address
First Line : 1090 MED PARK DR.
Second Line :
City : LAS CRUCES
State : NM
Zip : 88005-3236
Country : US
Telephone Number : 575-523-7243
Fax Number : 575-525-5641
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 06/20/2005
Last Update Date : 03/10/2022

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