Provider Demographics
NPI:1568223543
Name:GOAL PEDIATRIC ORTHOTICS LLC
Entity Type:Organization
Organization Name:GOAL PEDIATRIC ORTHOTICS LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:DAVID
Authorized Official - Middle Name:
Authorized Official - Last Name:PATTERSON
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:385-215-9985
Mailing Address - Street 1:471 E 1000 S STE D
Mailing Address - Street 2:
Mailing Address - City:PLEASANT GROVE
Mailing Address - State:UT
Mailing Address - Zip Code:84062-3694
Mailing Address - Country:US
Mailing Address - Phone:385-215-9985
Mailing Address - Fax:877-225-9880
Practice Address - Street 1:7138 S HIGHLAND DR STE 100
Practice Address - Street 2:
Practice Address - City:COTTONWOOD HEIGHTS
Practice Address - State:UT
Practice Address - Zip Code:84121-3757
Practice Address - Country:US
Practice Address - Phone:385-215-9985
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2024-01-17
Last Update Date:2024-01-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes335E00000XSuppliersProsthetic/Orthotic Supplier