Provider Demographics
NPI:1215567458
Name:GOLDSTEIN, NICHOLAUS (ATC)
Entity Type:Individual
Prefix:
First Name:NICHOLAUS
Middle Name:
Last Name:GOLDSTEIN
Suffix:
Gender:M
Credentials:ATC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:170 ATHLETICS CENTER
Mailing Address - Street 2:
Mailing Address - City:STILLWATER
Mailing Address - State:OK
Mailing Address - Zip Code:74078-4929
Mailing Address - Country:US
Mailing Address - Phone:970-622-8137
Mailing Address - Fax:
Practice Address - Street 1:170 ATHLETICS CENTER
Practice Address - Street 2:
Practice Address - City:STILLWATER
Practice Address - State:OK
Practice Address - Zip Code:74078-5578
Practice Address - Country:US
Practice Address - Phone:970-685-8839
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2020-01-15
Last Update Date:2022-08-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2255A2300XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersSpecialist/TechnologistAthletic Trainer