Basic Information
| Provider Information | |||||||||
| NPI: | 1588864334 | ||||||||
| EntityType: | 1 | ||||||||
| ReplacementNPI: | |||||||||
| OrganizationName: | |||||||||
| LastName: | GOLBERG | ||||||||
| FirstName: | ALEKSANDRA | ||||||||
| MiddleName: | |||||||||
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| Credential: | MSPT | ||||||||
| OtherOrganizationName: | |||||||||
| OtherOrganizationType: | |||||||||
| OtherLastName: | RASSIN | ||||||||
| OtherFirstName: | ALEKSANDRA | ||||||||
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| OtherCredential: | MSPT | ||||||||
| OtherLastNameType: | 1 | ||||||||
| Mailing Information | |||||||||
| Address1: | 6 BOURNE RD | ||||||||
| Address2: | |||||||||
| City: | FOXBORO | ||||||||
| State: | MA | ||||||||
| PostalCode: | 020351113 | ||||||||
| CountryCode: | US | ||||||||
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| Practice Location | |||||||||
| Address1: | 95 WASHINGTON ST | ||||||||
| Address2: | |||||||||
| City: | CANTON | ||||||||
| State: | MA | ||||||||
| PostalCode: | 020214006 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 7818287920 | ||||||||
| FaxNumber: | |||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 07/19/2007 | ||||||||
| LastUpdateDate: | 07/19/2007 | ||||||||
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| ProviderGenderCode: | F | ||||||||
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| IsSoleProprietor: | N | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 225100000X | 16873 | MA | Y | Respiratory, Developmental, Rehabilitative and Restorative Service Providers | Physical Therapist |
No ID Information.