Provider Demographics
NPI:1497721583
Name:GOLDIN, JOANNA MARY (PT)
Entity Type:Individual
Prefix:MRS
First Name:JOANNA
Middle Name:MARY
Last Name:GOLDIN
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 1:8652 E OTERO PL
Mailing Address - Street 2:
Mailing Address - City:CENTENNIAL
Mailing Address - State:CO
Mailing Address - Zip Code:80112-3317
Mailing Address - Country:US
Mailing Address - Phone:720-493-9123
Mailing Address - Fax:720-482-1345
Practice Address - Street 1:7340 S ALTON WAY
Practice Address - Street 2:STE 11-D
Practice Address - City:CENTENNIAL
Practice Address - State:CO
Practice Address - Zip Code:80112-2335
Practice Address - Country:US
Practice Address - Phone:720-493-1181
Practice Address - Fax:720-493-1191
Is Sole Proprietor?:Not Answered
Enumeration Date:2006-02-27
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CO4027225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist
Provider Identifiers
StateIdentifier IDID TypeIssuer
CO95439056Medicaid
COF6413Medicare ID - Type Unspecified