Provider Demographics
NPI:1609207083
Name:GOLDBERG, VICKI LYNN (PT)
Entity Type:Individual
Prefix:
First Name:VICKI
Middle Name:LYNN
Last Name:GOLDBERG
Suffix:
Gender:F
Credentials:PT
Other - Prefix:
Other - First Name:VICKI
Other - Middle Name:LYNN
Other - Last Name:PUSEY
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:PT
Mailing Address - Street 1:1200 CORPORATE DR STE 400
Mailing Address - Street 2:
Mailing Address - City:HOOVER
Mailing Address - State:AL
Mailing Address - Zip Code:35242-5424
Mailing Address - Country:US
Mailing Address - Phone:423-541-1974
Mailing Address - Fax:
Practice Address - Street 1:998 HOSPITALITY WAY STE 101
Practice Address - Street 2:
Practice Address - City:ABERDEEN
Practice Address - State:MD
Practice Address - Zip Code:21001-1757
Practice Address - Country:US
Practice Address - Phone:410-734-6556
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2013-12-10
Last Update Date:2021-04-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PAPT002565E225100000X
MD15988225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist