Provider Demographics
NPI:1093239741
Name:GOODSTEIN, DREW IAN
Entity Type:Individual
Prefix:
First Name:DREW
Middle Name:IAN
Last Name:GOODSTEIN
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:12450 NW 15TH PL APT 303
Mailing Address - Street 2:
Mailing Address - City:SUNRISE
Mailing Address - State:FL
Mailing Address - Zip Code:33323-5243
Mailing Address - Country:US
Mailing Address - Phone:754-204-7781
Mailing Address - Fax:
Practice Address - Street 1:881 NW 99TH AVE BAY 28
Practice Address - Street 2:
Practice Address - City:PEMBROKE PINES
Practice Address - State:FL
Practice Address - Zip Code:33024-6162
Practice Address - Country:US
Practice Address - Phone:954-437-8099
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2017-08-02
Last Update Date:2017-08-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLPTA27854225200000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225200000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapy Assistant