Provider Demographics
NPI:1104933019
Name:GOLDSTEIN, ARI DAVID (PT)
Entity type:Individual
Prefix:
First Name:ARI
Middle Name:DAVID
Last Name:GOLDSTEIN
Suffix:
Gender:M
Credentials:PT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:790 REMINGTON BLVD STE 220
Mailing Address - Street 2:
Mailing Address - City:BOLINGBROOK
Mailing Address - State:IL
Mailing Address - Zip Code:60440-4909
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:1295 E FLORENCE BLVD STE 1-3
Practice Address - Street 2:
Practice Address - City:CASA GRANDE
Practice Address - State:AZ
Practice Address - Zip Code:85122-4277
Practice Address - Country:US
Practice Address - Phone:520-494-3058
Practice Address - Fax:520-214-5059
Is Sole Proprietor?:No
Enumeration Date:2006-08-24
Last Update Date:2024-04-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AZ6838225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist
Provider Identifiers
StateIdentifier IDID TypeIssuer
AZ113061OtherMEDICARE TYPE B
AZ950502Medicaid
AZ113061OtherMEDICARE TYPE B