Provider Demographics
NPI:1750459079
Name:GOLDMAN, JEFFREY SCOTT (MSPT)
Entity Type:Individual
Prefix:MR
First Name:JEFFREY
Middle Name:SCOTT
Last Name:GOLDMAN
Suffix:
Gender:M
Credentials:MSPT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Credentials:
Mailing Address - Street 1:59 KENILWORTH ST
Mailing Address - Street 2:
Mailing Address - City:NEWTON
Mailing Address - State:MA
Mailing Address - Zip Code:02458-2705
Mailing Address - Country:US
Mailing Address - Phone:781-769-2040
Mailing Address - Fax:781-769-1914
Practice Address - Street 1:825 WASHINGTON ST
Practice Address - Street 2:STE 280 PHYSICAL THERAPY & SPORTS REHAB INC
Practice Address - City:NORWOOD
Practice Address - State:MA
Practice Address - Zip Code:02062
Practice Address - Country:US
Practice Address - Phone:781-769-2040
Practice Address - Fax:781-769-1914
Is Sole Proprietor?:No
Enumeration Date:2006-12-04
Last Update Date:2017-10-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MA10240225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist
Provider Identifiers
StateIdentifier IDID TypeIssuer
57043OtherFALLON
Y67543OtherBCBS
468123OtherTUFTS
57043OtherFALLON