Provider Demographics
NPI:1225264765
Name:GOLDENBERG, KIMBERLY I (PT)
Entity Type:Individual
Prefix:
First Name:KIMBERLY
Middle Name:I
Last Name:GOLDENBERG
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 1:555 N NEW BALLAS RD
Mailing Address - Street 2:SUITE 225
Mailing Address - City:SAINT LOUIS
Mailing Address - State:MO
Mailing Address - Zip Code:63141-6825
Mailing Address - Country:US
Mailing Address - Phone:314-997-8700
Mailing Address - Fax:314-997-8799
Practice Address - Street 1:555 N NEW BALLAS RD
Practice Address - Street 2:SUITE 225
Practice Address - City:SAINT LOUIS
Practice Address - State:MO
Practice Address - Zip Code:63141-6825
Practice Address - Country:US
Practice Address - Phone:314-997-8700
Practice Address - Fax:314-997-8799
Is Sole Proprietor?:No
Enumeration Date:2009-06-10
Last Update Date:2009-08-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MO111981225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist