Healthcare Provider Details

I. General information

NPI: 1104837582
Provider Name (Legal Business Name): ANDREW J GOETZ PT
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 08/10/2006
Last Update Date: 04/23/2026
Certification Date: 04/23/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

11042 STATE ROUTE 525 STE 134
CLINTON WA
98236-8618
US

IV. Provider business mailing address

PO BOX 643
CLINTON WA
98236-0643
US

V. Phone/Fax

Practice location:
  • Phone: 360-341-1299
  • Fax: 360-341-1277
Mailing address:
  • Phone: 360-341-1299
  • Fax: 360-341-1277

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code225100000X
TaxonomyPhysical Therapist
License NumberPT0003656
License Number StateWA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: