Provider Demographics
NPI:1215247713
Name:GOLDSON, ANDRE P (DPT)
Entity type:Individual
Prefix:
First Name:ANDRE
Middle Name:P
Last Name:GOLDSON
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 1:5530 WISCONSIN AVE STE 1650
Mailing Address - Street 2:
Mailing Address - City:CHEVY CHASE
Mailing Address - State:MD
Mailing Address - Zip Code:20815-4323
Mailing Address - Country:US
Mailing Address - Phone:301-657-9876
Mailing Address - Fax:301-657-8240
Practice Address - Street 1:5530 WISCONSIN AVE STE 1650
Practice Address - Street 2:
Practice Address - City:CHEVY CHASE
Practice Address - State:MD
Practice Address - Zip Code:20815-4323
Practice Address - Country:US
Practice Address - Phone:301-657-9876
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2010-10-18
Last Update Date:2020-08-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA2305206692225100000X
DCPT871203225100000X
MD23461225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist