Provider Demographics
NPI:1336118959
Name:GOLDMAN, LORRAINE VERONICA PREZALAR (PT)
Entity Type:Individual
Prefix:
First Name:LORRAINE
Middle Name:VERONICA PREZALAR
Last Name:GOLDMAN
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 1:2508 E WILLOW ST
Mailing Address - Street 2:#209
Mailing Address - City:SIGNAL HILL
Mailing Address - State:CA
Mailing Address - Zip Code:90755-2242
Mailing Address - Country:US
Mailing Address - Phone:562-833-5832
Mailing Address - Fax:
Practice Address - Street 1:2508 E WILLOW ST
Practice Address - Street 2:#209
Practice Address - City:SIGNAL HILL
Practice Address - State:CA
Practice Address - Zip Code:90755-2242
Practice Address - Country:US
Practice Address - Phone:562-833-5832
Practice Address - Fax:
Is Sole Proprietor?:Not Answered
Enumeration Date:2006-03-16
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAPT19817225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist