Provider Demographics
NPI:1770912883
Name:GOLDBERG, JAMISON (DPT)
Entity type:Individual
Prefix:DR
First Name:JAMISON
Middle Name:
Last Name:GOLDBERG
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 1:3000 CORAL WAY
Mailing Address - Street 2:UNIT 716
Mailing Address - City:CORAL GABLES
Mailing Address - State:FL
Mailing Address - Zip Code:33145-3243
Mailing Address - Country:US
Mailing Address - Phone:914-494-2759
Mailing Address - Fax:
Practice Address - Street 1:20754 W DIXIE HWY
Practice Address - Street 2:
Practice Address - City:AVENTURA
Practice Address - State:FL
Practice Address - Zip Code:33180-1146
Practice Address - Country:US
Practice Address - Phone:305-935-9599
Practice Address - Fax:305-932-5612
Is Sole Proprietor?:No
Enumeration Date:2013-11-08
Last Update Date:2013-11-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLPT28468225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist