Provider Demographics
NPI:1972514164
Name:GOLTSCHMAN, DEBORAH A (MPT)
Entity type:Individual
Prefix:MRS
First Name:DEBORAH
Middle Name:A
Last Name:GOLTSCHMAN
Suffix:
Gender:F
Credentials:MPT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Credentials:
Mailing Address - Street 1:4850 LEMAY FERRY RD
Mailing Address - Street 2:SUITE 101
Mailing Address - City:SAINT LOUIS
Mailing Address - State:MO
Mailing Address - Zip Code:63129-1576
Mailing Address - Country:US
Mailing Address - Phone:314-416-0439
Mailing Address - Fax:314-416-7626
Practice Address - Street 1:4850 LEMAY FERRY RD
Practice Address - Street 2:SUITE 101
Practice Address - City:SAINT LOUIS
Practice Address - State:MO
Practice Address - Zip Code:63129-1576
Practice Address - Country:US
Practice Address - Phone:314-315-0986
Practice Address - Fax:314-416-7184
Is Sole Proprietor?:No
Enumeration Date:2006-08-11
Last Update Date:2010-01-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MO118243225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist
Provider Identifiers
StateIdentifier IDID TypeIssuer
MO990001833Medicare ID - Type Unspecified