Provider Demographics
NPI:1851950679
Name:GOLDBERG, ANDREA H (PT)
Entity Type:Individual
Prefix:
First Name:ANDREA
Middle Name:H
Last Name:GOLDBERG
Suffix:
Gender:F
Credentials:PT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:5851 TIMUQUANA RD STE 303
Mailing Address - Street 2:
Mailing Address - City:JACKSONVILLE
Mailing Address - State:FL
Mailing Address - Zip Code:32210-7899
Mailing Address - Country:US
Mailing Address - Phone:904-674-2699
Mailing Address - Fax:904-674-6710
Practice Address - Street 1:5851 TIMUQUANA RD STE 303
Practice Address - Street 2:
Practice Address - City:JACKSONVILLE
Practice Address - State:FL
Practice Address - Zip Code:32210-7899
Practice Address - Country:US
Practice Address - Phone:904-674-2699
Practice Address - Fax:904-674-6710
Is Sole Proprietor?:No
Enumeration Date:2019-06-06
Last Update Date:2019-06-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLPT21780225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist