Healthcare Provider Details

I. General information

NPI: 1972414126
Provider Name (Legal Business Name): JESSALYN GOETZ PT, DPT
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 09/16/2026
Last Update Date: 09/16/2026
Certification Date: 09/16/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

7 HEMPHILL PL STE 130
MALTA NY
12020-4482
US

IV. Provider business mailing address

58 HARDEN RD
FERNDALE NY
12734-5715
US

V. Phone/Fax

Practice location:
  • Phone: 518-289-5242
  • Fax: 518-289-5294
Mailing address:
  • Phone: 518-289-5242
  • Fax: 518-289-5294

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code225100000X
TaxonomyPhysical Therapist
License Number056387
License Number StateNY

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: