Provider Demographics
NPI:1619944121
Name:GOLDSMITH, PHILIP R (PT, MSPT, EMT, DSCPT)
Entity Type:Individual
Prefix:DR
First Name:PHILIP
Middle Name:R
Last Name:GOLDSMITH
Suffix:
Gender:M
Credentials:PT, MSPT, EMT, DSCPT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:142 VISTA LOOP
Mailing Address - Street 2:
Mailing Address - City:HANOVER
Mailing Address - State:PA
Mailing Address - Zip Code:17331-7458
Mailing Address - Country:US
Mailing Address - Phone:443-465-3647
Mailing Address - Fax:
Practice Address - Street 1:142 VISTA LOOP
Practice Address - Street 2:
Practice Address - City:HANOVER
Practice Address - State:PA
Practice Address - Zip Code:17331-7458
Practice Address - Country:US
Practice Address - Phone:443-863-9010
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2006-03-02
Last Update Date:2022-04-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MD0170368146N00000X
PA110751146N00000X
PAPT019655225100000X
MD21290225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist
No146N00000XEmergency Medical Service ProvidersEmergency Medical Technician, Basic