Basic Information
| Provider Information | |||||||||
| NPI: | 1154439313 | ||||||||
| EntityType: | 1 | ||||||||
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| OrganizationName: | |||||||||
| LastName: | GOLDIN | ||||||||
| FirstName: | ALEJANDRO | ||||||||
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| Mailing Information | |||||||||
| Address1: | 11825 ROYAL PALM BLVD APT 103 | ||||||||
| Address2: | |||||||||
| City: | CORAL SPRINGS | ||||||||
| State: | FL | ||||||||
| PostalCode: | 330657338 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 9545752626 | ||||||||
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| Practice Location | |||||||||
| Address1: | 2804 N UNIVERSITY DR | ||||||||
| Address2: | |||||||||
| City: | CORAL SPRINGS | ||||||||
| State: | FL | ||||||||
| PostalCode: | 330655010 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 9542278040 | ||||||||
| FaxNumber: | 9542278046 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 08/28/2006 | ||||||||
| LastUpdateDate: | 07/08/2007 | ||||||||
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| ProviderGenderCode: | M | ||||||||
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| IsSoleProprietor: | N | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 225100000X | Y | Respiratory, Developmental, Rehabilitative and Restorative Service Providers | Physical Therapist |
ID Information
| ID | Type | State | Issuer | Description | PT6241 | 01 | FL | LICENSE # | OTHER |