Provider Demographics
NPI:1114136157
Name:GOLDBERG, CYNTHIA LYN (PT, AT, C)
Entity Type:Individual
Prefix:MRS
First Name:CYNTHIA
Middle Name:LYN
Last Name:GOLDBERG
Suffix:
Gender:F
Credentials:PT, AT, C
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1311 BENBROOKE LN NW
Mailing Address - Street 2:
Mailing Address - City:ACWORTH
Mailing Address - State:GA
Mailing Address - Zip Code:30101-8492
Mailing Address - Country:US
Mailing Address - Phone:678-358-4328
Mailing Address - Fax:267-321-2546
Practice Address - Street 1:1311 BENBROOKE LN NW
Practice Address - Street 2:
Practice Address - City:ACWORTH
Practice Address - State:GA
Practice Address - Zip Code:30101-8492
Practice Address - Country:US
Practice Address - Phone:678-358-4328
Practice Address - Fax:267-321-2546
Is Sole Proprietor?:No
Enumeration Date:2007-05-22
Last Update Date:2011-04-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GAPT2071225100000X
GA20712251X0800X
GA752255A2300X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist
No2251X0800XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical TherapistOrthopedic
No2255A2300XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersSpecialist/TechnologistAthletic Trainer
Provider Identifiers
StateIdentifier IDID TypeIssuer
GA511I650078Medicare PIN
GA65BBCPJMedicare ID - Type Unspecified