Provider Demographics
NPI:1356537252
Name:GOLDSTEIN, KATHLEEN WALSH (PT)
Entity type:Individual
Prefix:MS
First Name:KATHLEEN
Middle Name:WALSH
Last Name:GOLDSTEIN
Suffix:
Gender:F
Credentials:PT
Other - Prefix:MS
Other - First Name:KATHLEEN
Other - Middle Name:ANN
Other - Last Name:WALSH
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:PT
Mailing Address - Street 1:342 OXHEAD RD
Mailing Address - Street 2:
Mailing Address - City:STONY BROOK
Mailing Address - State:NY
Mailing Address - Zip Code:11790-2303
Mailing Address - Country:US
Mailing Address - Phone:631-689-8226
Mailing Address - Fax:
Practice Address - Street 1:342 OXHEAD RD
Practice Address - Street 2:
Practice Address - City:STONY BROOK
Practice Address - State:NY
Practice Address - Zip Code:11790-2303
Practice Address - Country:US
Practice Address - Phone:631-689-8226
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2007-09-24
Last Update Date:2007-09-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY013302225100000X
WI3857-024225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist