Provider Demographics
NPI:1801502554
Name:GOLDEN, STEPHEN LAMONN JR (PTA)
Entity type:Individual
Prefix:MR
First Name:STEPHEN
Middle Name:LAMONN
Last Name:GOLDEN
Suffix:JR
Gender:M
Credentials:PTA
Other - Prefix:
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Mailing Address - Street 1:108 MADEIRA AVE APT 2
Mailing Address - Street 2:
Mailing Address - City:CORAL GABLES
Mailing Address - State:FL
Mailing Address - Zip Code:33134-4543
Mailing Address - Country:US
Mailing Address - Phone:309-737-7516
Mailing Address - Fax:
Practice Address - Street 1:126 MADEIRA AVE
Practice Address - Street 2:
Practice Address - City:CORAL GABLES
Practice Address - State:FL
Practice Address - Zip Code:33134-4516
Practice Address - Country:US
Practice Address - Phone:786-309-8877
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2023-01-26
Last Update Date:2023-01-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLPTA31588225200000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225200000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapy Assistant