Provider Demographics
NPI:1831320845
Name:GOLDEN, SANATAN (DPT)
Entity Type:Individual
Prefix:
First Name:SANATAN
Middle Name:
Last Name:GOLDEN
Suffix:
Gender:M
Credentials:DPT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:511 SW 10TH AVE
Mailing Address - Street 2:#101
Mailing Address - City:PORTLAND
Mailing Address - State:OR
Mailing Address - Zip Code:97205-2732
Mailing Address - Country:US
Mailing Address - Phone:503-294-7463
Mailing Address - Fax:503-294-7405
Practice Address - Street 1:511 SW 10TH AVE
Practice Address - Street 2:#101
Practice Address - City:PORTLAND
Practice Address - State:OR
Practice Address - Zip Code:97205-2732
Practice Address - Country:US
Practice Address - Phone:503-294-7463
Practice Address - Fax:503-294-7405
Is Sole Proprietor?:No
Enumeration Date:2009-08-07
Last Update Date:2013-09-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WAPT60096812225100000X
OR6301225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist
Provider Identifiers
StateIdentifier IDID TypeIssuer
OR500625644Medicaid
OR500625644Medicaid
ORR157402Medicare PIN