Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
N | 225100000X | Physical Therapist | PT21585 | CA |
Y | 2251P0200X | Physical Therapist - Pediatrics | 2045 | HI |
N | 2251P0200X | Physical Therapist - Pediatrics | PT21585 | CA |
NPI | 1093752743 |
---|---|
Provider Name | Michelle Goldstein |
First Address | Kailua, HI 96734-3358 |
Second Address | Kailua, HI 96734-3358 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 01/06/2006 |
Last Update Date | 11/01/2011 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
VAD000 | (02) | HI |