Provider Demographics
NPI:1851677413
Name:GOLDBERG, KENDALL PAIGE (MLA, ATC, LAT)
Entity Type:Individual
Prefix:
First Name:KENDALL
Middle Name:PAIGE
Last Name:GOLDBERG
Suffix:
Gender:F
Credentials:MLA, ATC, LAT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:870 N CHARLOTTE AVE
Mailing Address - Street 2:
Mailing Address - City:STEPHENVILLE
Mailing Address - State:TX
Mailing Address - Zip Code:76401-2811
Mailing Address - Country:US
Mailing Address - Phone:940-642-9227
Mailing Address - Fax:
Practice Address - Street 1:2650 W OVERHILL DR
Practice Address - Street 2:
Practice Address - City:STEPHENVILLE
Practice Address - State:TX
Practice Address - Zip Code:76401-1972
Practice Address - Country:US
Practice Address - Phone:254-552-6425
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2011-10-27
Last Update Date:2011-10-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TXAT41012255A2300X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2255A2300XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersSpecialist/TechnologistAthletic Trainer