Healthcare Provider Details

I. General information

NPI: 1063196095
Provider Name (Legal Business Name): HANNAH GOETTL DPT
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 06/12/2023
Last Update Date: 05/12/2025
Certification Date: 05/12/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

555 RAILROAD DR NW STE C
ELK RIVER MN
55330-1469
US

IV. Provider business mailing address

7140 QUARRY AVE NE
OTSEGO MN
55330-4620
US

V. Phone/Fax

Practice location:
  • Phone: 763-441-8111
  • Fax:
Mailing address:
  • Phone: 612-963-7846
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code225100000X
TaxonomyPhysical Therapist
License Number
License Number StateMN
# 2
Primary TaxonomyN
Taxonomy Code225100000X
TaxonomyPhysical Therapist
License Number13092
License Number StateMN

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: