MEDICARE: JEFFREY GOETZ

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	225100000X	Physical Therapist

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number	:	1073195665
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	JEFFREY GOETZ

Provider Business Mailing Address
First Line	:	PO BOX 681478
Second Line	:
City	:	FRANKLIN
State	:	TN
Zip	:	37068-1478
Country	:	US
Telephone Number	:	615-591-6590
Fax Number	:	615-591-6601

Provider Business Practice Location Address
First Line	:	151 ADAMS LN STE 11
Second Line	:
City	:	MT JULIET
State	:	TN
Zip	:	37122-8320
Country	:	US
Telephone Number	:	615-773-1561
Fax Number	:	615-773-1564

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	04/23/2021
Last Update Date	:	04/23/2021

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Directions to “ JEFFREY GOETZ ” Practice Location

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