Healthcare Provider Details

I. General information

NPI: 1306947841
Provider Name (Legal Business Name): SOUTH WHIDBEY PHYSICAL THERAPY AND SPORTS CLINIC INC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 09/26/2006
Last Update Date: 10/17/2023
Certification Date: 10/17/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

11042 SR 525 # 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 Code261QP2000X
TaxonomyPhysical Therapy Clinic/Center
License Number601918262
License Number StateWA

VIII. Authorized Official

Name: ANDREW JOSEPH GOETZ
Title or Position: OWNER/PHYSICAL THERAPIST
Credential: PT
Phone: 360-341-1299