Provider Demographics
NPI:1225306459
Name:GOLDSTEIN, MARY A (PT)
Entity Type:Individual
Prefix:
First Name:MARY
Middle Name:A
Last Name:GOLDSTEIN
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 1:12656 W GEAUGA PLZ
Mailing Address - Street 2:
Mailing Address - City:CHESTERLAND
Mailing Address - State:OH
Mailing Address - Zip Code:44026-2505
Mailing Address - Country:US
Mailing Address - Phone:216-288-6957
Mailing Address - Fax:440-760-4006
Practice Address - Street 1:12656 W GEAUGA PLZ
Practice Address - Street 2:
Practice Address - City:CHESTERLAND
Practice Address - State:OH
Practice Address - Zip Code:44026-2505
Practice Address - Country:US
Practice Address - Phone:216-288-6957
Practice Address - Fax:440-760-4006
Is Sole Proprietor?:No
Enumeration Date:2011-12-02
Last Update Date:2011-12-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH003844225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist