Provider Demographics
NPI:1689881906
Name:GOLDBERG, CINDY (PT)
Entity Type:Individual
Prefix:MS
First Name:CINDY
Middle Name:
Last Name:GOLDBERG
Suffix:
Gender:F
Credentials:PT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:840 PEMBROKE RD
Mailing Address - Street 2:
Mailing Address - City:RYDAL
Mailing Address - State:PA
Mailing Address - Zip Code:19046-3419
Mailing Address - Country:US
Mailing Address - Phone:215-885-6590
Mailing Address - Fax:215-885-6591
Practice Address - Street 1:840 PEMBROKE RD
Practice Address - Street 2:
Practice Address - City:RYDAL
Practice Address - State:PA
Practice Address - Zip Code:19046-3419
Practice Address - Country:US
Practice Address - Phone:215-885-6590
Practice Address - Fax:215-885-6591
Is Sole Proprietor?:No
Enumeration Date:2007-05-17
Last Update Date:2007-07-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PAPT-003182-L225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist
Provider Identifiers
StateIdentifier IDID TypeIssuer
PA0019308540001Medicaid