Provider Demographics
NPI:1750713392
Name:GOLDBERG, JACQUELINE K (PT, DPT)
Entity type:Individual
Prefix:
First Name:JACQUELINE
Middle Name:K
Last Name:GOLDBERG
Suffix:
Gender:F
Credentials:PT, DPT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:8455 FANNIN ST
Mailing Address - Street 2:SUITE B
Mailing Address - City:HOUSTON
Mailing Address - State:TX
Mailing Address - Zip Code:77054-4803
Mailing Address - Country:US
Mailing Address - Phone:713-795-0891
Mailing Address - Fax:713-797-0049
Practice Address - Street 1:8515 FANNIN ST STE B
Practice Address - Street 2:
Practice Address - City:HOUSTON
Practice Address - State:TX
Practice Address - Zip Code:77054-4811
Practice Address - Country:US
Practice Address - Phone:713-795-0891
Practice Address - Fax:713-797-0049
Is Sole Proprietor?:No
Enumeration Date:2013-08-06
Last Update Date:2022-05-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX1233336225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist