Provider Demographics
NPI:1821732686
Name:GOLDBERG, ELIZABETH HANNA (LMT)
Entity Type:Individual
Prefix:
First Name:ELIZABETH
Middle Name:HANNA
Last Name:GOLDBERG
Suffix:
Gender:F
Credentials:LMT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2714 ONTARIO RD NW UNIT 3
Mailing Address - Street 2:
Mailing Address - City:WASHINGTON
Mailing Address - State:DC
Mailing Address - Zip Code:20009-2387
Mailing Address - Country:US
Mailing Address - Phone:201-803-1880
Mailing Address - Fax:
Practice Address - Street 1:1705 DESALES ST NW FL 6
Practice Address - Street 2:
Practice Address - City:WASHINGTON
Practice Address - State:DC
Practice Address - Zip Code:20036-4405
Practice Address - Country:US
Practice Address - Phone:201-803-1880
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2022-04-26
Last Update Date:2022-04-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
DCMT1861225700000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225700000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersMassage Therapist