Provider Demographics
NPI:1073686887
Name:GO, ASTRID THERESE
Entity Type:Individual
Prefix:
First Name:ASTRID
Middle Name:THERESE
Last Name:GO
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2500 QUANTUM LAKES DR
Mailing Address - Street 2:SUITE 108
Mailing Address - City:BOYNTON BEACH
Mailing Address - State:FL
Mailing Address - Zip Code:33426-8324
Mailing Address - Country:US
Mailing Address - Phone:561-244-3627
Mailing Address - Fax:561-244-9627
Practice Address - Street 1:2500 QUANTUM LAKES DR
Practice Address - Street 2:SUITE 108
Practice Address - City:BOYNTON BEACH
Practice Address - State:FL
Practice Address - Zip Code:33426-8324
Practice Address - Country:US
Practice Address - Phone:561-244-3627
Practice Address - Fax:561-244-9627
Is Sole Proprietor?:Yes
Enumeration Date:2006-11-17
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLPT008763225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist
Provider Identifiers
StateIdentifier IDID TypeIssuer
FLPT008763OtherPHYSICAL THERAPIST