Provider Demographics
NPI:1659457356
Name:GOLDBERG, DAVID A (PT)
Entity Type:Individual
Prefix:
First Name:DAVID
Middle Name:A
Last Name:GOLDBERG
Suffix:
Gender:M
Credentials:PT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:790 REMINGTON BLVD
Mailing Address - Street 2:
Mailing Address - City:BOLINGBROOK
Mailing Address - State:IL
Mailing Address - Zip Code:60440-4909
Mailing Address - Country:US
Mailing Address - Phone:630-296-2223
Mailing Address - Fax:
Practice Address - Street 1:200 PATEWOOD DR
Practice Address - Street 2:STE C150
Practice Address - City:GREENVILLE
Practice Address - State:SC
Practice Address - Zip Code:29615-3593
Practice Address - Country:US
Practice Address - Phone:864-454-0904
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2006-10-27
Last Update Date:2015-11-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
SC1367225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist
Provider Identifiers
StateIdentifier IDID TypeIssuer
SC20-2312101OtherBLUE CHOICE
SC20-2312101OtherPREMIER
SC20-2312101OtherUHC
SCP00228285OtherMEDICARE RAILROAD
SC20-2312101OtherCAROLINA CARE PLAN
SC9799717OtherCIGNA
SCDD4407OtherMEDICARE RAILROAD GRP
SCE2939OtherMEDCOST
SCTH0916Medicaid
20-2312101OtherFOCUS
SC20-2312101OtherGREATWEST
SC20-2312101OtherBCBS OF SOUTH CAROLINA
SC20-2312101OtherKANAWHA
SC20-2312101OtherTRICARE
SC607756100OtherDEPT OF LABOR
SC7761758OtherAETNA
SCE2939OtherMEDCOST