| NPI | 1790876761 |
|---|---|
| Former Name | STACEY M GOLDMAN |
| Entity Type | Individual |
| Gender | Female |
| Sole Proprietor ? | No |
| Primary Taxonomy | 225100000X Physical Therapist (Licence: NY 024094) |
| Additional Taxonomies | 225100000X Physical Therapist (Licence: NJ 40QA00987600) |
| Enumeration Date | 2006-09-27 |
| Last Update Date | 2011-12-07 |