Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 225100000X | Physical Therapist | PT28074 | CA |
N | 2251X0800X | Physical Therapist - Orthopedic | PT28074 | CA |
NPI | 1053688358 |
---|---|
Provider Name | Timothy Scott Goldberg |
First Address | Mission Viejo, CA 92691 |
Second Address | Orange, CA 92868 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 30/11/2011 |
Last Update Date | 31/03/2016 |