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General NPI Number Information
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NPI Number | 1285101766
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Entity Type | Individual
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Provider Name | JESSICA GOETZ
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Gender | Female
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Dates
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Enumeration Date | 11/01/2018
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Last Update Date | 11/01/2018
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Provider Practice Location Address
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Address Line | W180N8071 TOWN HALL RD
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City | MENOMONEE FALLS
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State | WI
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Zip | 53051-3518
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Country | US
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Telephone | 262-253-2700
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Fax |
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Provider Business Mailing Address
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Address Line | 21782 N WEATHER EDGE CIR
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City | LANNON
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State | WI
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Zip | 53046-9623
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Country | US
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Telephone |
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Fax |
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 2251G0304X
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Taxonomy Name | Geriatric Physical Therapist
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License Number |
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License Number State |
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