Provider Demographics
NPI:1487785523
Name:GOLDSTEIN, DANIEL FREDERICK (PT, OCS, SCS, ATC)
Entity type:Individual
Prefix:MR
First Name:DANIEL
Middle Name:FREDERICK
Last Name:GOLDSTEIN
Suffix:
Gender:M
Credentials:PT, OCS, SCS, ATC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1896 PALM BEACH LAKES BLVD
Mailing Address - Street 2:STE 101
Mailing Address - City:WEST PALM BEACH
Mailing Address - State:FL
Mailing Address - Zip Code:33409-3510
Mailing Address - Country:US
Mailing Address - Phone:561-371-6021
Mailing Address - Fax:561-686-4815
Practice Address - Street 1:1896 PALM BEACH LAKES BLVD
Practice Address - Street 2:SUITE B
Practice Address - City:WEST PALM BEACH
Practice Address - State:FL
Practice Address - Zip Code:33409-3513
Practice Address - Country:US
Practice Address - Phone:561-371-6021
Practice Address - Fax:561-686-4815
Is Sole Proprietor?:Yes
Enumeration Date:2007-03-08
Last Update Date:2017-02-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLPT3382225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist
Provider Identifiers
StateIdentifier IDID TypeIssuer
FLY2159Medicare ID - Type Unspecified