Provider Demographics
NPI:1114026143
Name:GOLDMAN, JENNIFER (PT)
Entity Type:Individual
Prefix:MS
First Name:JENNIFER
Middle Name:
Last Name:GOLDMAN
Suffix:
Gender:F
Credentials:PT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:10282 ISLANDER DR
Mailing Address - Street 2:
Mailing Address - City:BOCA RATON
Mailing Address - State:FL
Mailing Address - Zip Code:33498-6306
Mailing Address - Country:US
Mailing Address - Phone:561-702-4899
Mailing Address - Fax:561-477-8794
Practice Address - Street 1:10282 ISLANDER DR
Practice Address - Street 2:
Practice Address - City:BOCA RATON
Practice Address - State:FL
Practice Address - Zip Code:33498-6306
Practice Address - Country:US
Practice Address - Phone:561-218-8800
Practice Address - Fax:561-477-8794
Is Sole Proprietor?:Yes
Enumeration Date:2006-09-22
Last Update Date:2022-05-31
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLPT18423225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist
Provider Identifiers
StateIdentifier IDID TypeIssuer
FLU3753Medicare ID - Type UnspecifiedPROVIDER NUMBER