Provider Demographics
NPI:1336843796
Name:GOOLSBY, JENNIFER R (ATC)
Entity Type:Individual
Prefix:MRS
First Name:JENNIFER
Middle Name:R
Last Name:GOOLSBY
Suffix:
Gender:F
Credentials:ATC
Other - Prefix:MS
Other - First Name:JENNIFER
Other - Middle Name:
Other - Last Name:GOLDBERG
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:ATC
Mailing Address - Street 1:285 RUNNINGBOARD RD
Mailing Address - Street 2:
Mailing Address - City:STEWARTSTOWN
Mailing Address - State:PA
Mailing Address - Zip Code:17363-8353
Mailing Address - Country:US
Mailing Address - Phone:410-428-1009
Mailing Address - Fax:
Practice Address - Street 1:285 RUNNINGBOARD RD
Practice Address - Street 2:
Practice Address - City:STEWARTSTOWN
Practice Address - State:PA
Practice Address - Zip Code:17363-8353
Practice Address - Country:US
Practice Address - Phone:410-428-1009
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2023-03-29
Last Update Date:2023-03-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MDA0003882255A2300X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2255A2300XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersSpecialist/TechnologistAthletic Trainer