Provider Demographics
NPI:1043600471
Name:GOLDSMITH, RONALD SR (PTA)
Entity Type:Individual
Prefix:MR
First Name:RONALD
Middle Name:
Last Name:GOLDSMITH
Suffix:SR
Gender:M
Credentials:PTA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1452 LOVAT CT
Mailing Address - Street 2:
Mailing Address - City:RIVERSIDE
Mailing Address - State:CA
Mailing Address - Zip Code:92507-6463
Mailing Address - Country:US
Mailing Address - Phone:909-838-6783
Mailing Address - Fax:
Practice Address - Street 1:1452 LOVAT CT
Practice Address - Street 2:
Practice Address - City:RIVERSIDE
Practice Address - State:CA
Practice Address - Zip Code:92507-6463
Practice Address - Country:US
Practice Address - Phone:909-838-6783
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2015-01-23
Last Update Date:2015-01-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAAT4813225200000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225200000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapy Assistant