Provider Demographics
NPI:1033285317
Name:GOLDSTEIN, SANFORD A (PT)
Entity Type:Individual
Prefix:
First Name:SANFORD
Middle Name:A
Last Name:GOLDSTEIN
Suffix:
Gender:M
Credentials:PT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2005 W 14TH ST
Mailing Address - Street 2:SUITE 136
Mailing Address - City:TEMPE
Mailing Address - State:AZ
Mailing Address - Zip Code:85281-6925
Mailing Address - Country:US
Mailing Address - Phone:480-967-2900
Mailing Address - Fax:480-967-3005
Practice Address - Street 1:4902 S VAL VISTA DR
Practice Address - Street 2:SUITE B-102
Practice Address - City:GILBERT
Practice Address - State:AZ
Practice Address - Zip Code:85298-7325
Practice Address - Country:US
Practice Address - Phone:480-855-8866
Practice Address - Fax:480-855-8867
Is Sole Proprietor?:No
Enumeration Date:2006-11-28
Last Update Date:2009-07-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AZ7411225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist
Provider Identifiers
StateIdentifier IDID TypeIssuer
AZ194529Medicaid
AZ194529Medicaid
AZZ112510Medicare UPIN