Provider Demographics
NPI:1821213836
Name:GOLDBERG, DENA (MSPT)
Entity Type:Individual
Prefix:
First Name:DENA
Middle Name:
Last Name:GOLDBERG
Suffix:
Gender:F
Credentials:MSPT
Other - Prefix:
Other - First Name:DENA
Other - Middle Name:
Other - Last Name:BARAM
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:MSPT
Mailing Address - Street 1:32 HEMLOCK ST
Mailing Address - Street 2:
Mailing Address - City:MANCHESTER
Mailing Address - State:CT
Mailing Address - Zip Code:06040-4016
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:155 WOODSTOCK AVE
Practice Address - Street 2:
Practice Address - City:RUTLAND
Practice Address - State:VT
Practice Address - Zip Code:05701-3587
Practice Address - Country:US
Practice Address - Phone:027-727-8018
Practice Address - Fax:802-855-8698
Is Sole Proprietor?:No
Enumeration Date:2007-04-16
Last Update Date:2019-08-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VT040.0003749225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist