Provider Demographics
NPI:1457627663
Name:GOLDSTEIN, EDWARD LEE (PT)
Entity Type:Individual
Prefix:MR
First Name:EDWARD
Middle Name:LEE
Last Name:GOLDSTEIN
Suffix:
Gender:M
Credentials:PT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:13905 ADDISON ST.
Mailing Address - Street 2:EDWARD GOLDSTEIN: HOME HEALTH PHYSICAL THERAPY
Mailing Address - City:SHERMAN OAKS
Mailing Address - State:CA
Mailing Address - Zip Code:91423
Mailing Address - Country:US
Mailing Address - Phone:818-789-5653
Mailing Address - Fax:
Practice Address - Street 1:13905 ADDISON ST.
Practice Address - Street 2:HOME HEALTH PHYSICAL THERAPY
Practice Address - City:SHERMAN OAKS
Practice Address - State:CA
Practice Address - Zip Code:91423
Practice Address - Country:US
Practice Address - Phone:818-789-5653
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2012-04-02
Last Update Date:2012-04-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAPT5297225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist