Provider Demographics
NPI:1447864806
Name:ANDONOVSKI, GORAN (DPT)
Entity type:Individual
Prefix:DR
First Name:GORAN
Middle Name:
Last Name:ANDONOVSKI
Suffix:
Gender:M
Credentials:DPT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4087 RITA LN
Mailing Address - Street 2:
Mailing Address - City:BONITA SPRINGS
Mailing Address - State:FL
Mailing Address - Zip Code:34134-4036
Mailing Address - Country:US
Mailing Address - Phone:330-388-0352
Mailing Address - Fax:
Practice Address - Street 1:3108 SANTA BARBARA BLVD STE D
Practice Address - Street 2:
Practice Address - City:CAPE CORAL
Practice Address - State:FL
Practice Address - Zip Code:33914-4537
Practice Address - Country:US
Practice Address - Phone:239-257-1431
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2020-09-03
Last Update Date:2020-09-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLPT36209208100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208100000XAllopathic & Osteopathic PhysiciansPhysical Medicine & Rehabilitation