Provider Demographics
NPI:1598916298
Name:GOLLER, MARC DAVID (RPT)
Entity Type:Individual
Prefix:
First Name:MARC
Middle Name:DAVID
Last Name:GOLLER
Suffix:
Gender:M
Credentials:RPT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:390 SE 2ND AVE
Mailing Address - Street 2:J3
Mailing Address - City:DEERFIELD BEACH
Mailing Address - State:FL
Mailing Address - Zip Code:33441-4721
Mailing Address - Country:US
Mailing Address - Phone:954-697-1688
Mailing Address - Fax:954-697-1688
Practice Address - Street 1:390 SE 2ND AVE
Practice Address - Street 2:J3
Practice Address - City:DEERFIELD BEACH
Practice Address - State:FL
Practice Address - Zip Code:33441-4721
Practice Address - Country:US
Practice Address - Phone:954-697-1688
Practice Address - Fax:954-697-1688
Is Sole Proprietor?:Yes
Enumeration Date:2008-10-01
Last Update Date:2008-10-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLPT14905225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist