Provider Demographics
NPI:1265655930
Name:GOLDRING, ROMAN (MPT)
Entity Type:Individual
Prefix:MR
First Name:ROMAN
Middle Name:
Last Name:GOLDRING
Suffix:
Gender:M
Credentials:MPT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:967 HAMMOND ST APT 6
Mailing Address - Street 2:
Mailing Address - City:WEST HOLLYWOOD
Mailing Address - State:CA
Mailing Address - Zip Code:90069-4431
Mailing Address - Country:US
Mailing Address - Phone:310-666-4776
Mailing Address - Fax:
Practice Address - Street 1:1304 15TH ST STE 407
Practice Address - Street 2:
Practice Address - City:SANTA MONICA
Practice Address - State:CA
Practice Address - Zip Code:90404-1813
Practice Address - Country:US
Practice Address - Phone:310-393-9292
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2007-04-11
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA29873225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist