Provider Demographics
NPI:1144415571
Name:GOLDMAN, ROBERT A (PT)
Entity Type:Individual
Prefix:
First Name:ROBERT
Middle Name:A
Last Name:GOLDMAN
Suffix:
Gender:M
Credentials:PT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1807 SE 41ST ST
Mailing Address - Street 2:#11
Mailing Address - City:CAPE CORAL
Mailing Address - State:FL
Mailing Address - Zip Code:33904-6003
Mailing Address - Country:US
Mailing Address - Phone:239-432-0774
Mailing Address - Fax:239-432-0229
Practice Address - Street 1:12700 CREEKSIDE LN
Practice Address - Street 2:SUITE 101
Practice Address - City:FORT MYERS
Practice Address - State:FL
Practice Address - Zip Code:33919-3356
Practice Address - Country:US
Practice Address - Phone:239-432-0774
Practice Address - Fax:239-432-0229
Is Sole Proprietor?:No
Enumeration Date:2007-09-10
Last Update Date:2007-09-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLPT22544225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist