Provider Demographics
NPI:1417263062
Name:GOLEBIESKI, DUSTIN MICHAEL (DPT)
Entity Type:Individual
Prefix:
First Name:DUSTIN
Middle Name:MICHAEL
Last Name:GOLEBIESKI
Suffix:
Gender:M
Credentials:DPT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:160 PEDRO WAY
Mailing Address - Street 2:
Mailing Address - City:WINCHESTER
Mailing Address - State:KY
Mailing Address - Zip Code:40391-8354
Mailing Address - Country:US
Mailing Address - Phone:859-745-2152
Mailing Address - Fax:859-745-2153
Practice Address - Street 1:120 N WATER ST
Practice Address - Street 2:
Practice Address - City:GEORGETOWN
Practice Address - State:KY
Practice Address - Zip Code:40324-1354
Practice Address - Country:US
Practice Address - Phone:859-559-7576
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2010-08-20
Last Update Date:2021-03-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WV002857225100000X
KY005729225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist
Provider Identifiers
StateIdentifier IDID TypeIssuer
P00858199OtherMEDICARE RAILROAD
WV3810019101Medicaid
WV3810019101Medicaid