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General NPI Number Information
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NPI Number | 1982901203
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Entity Type | Individual
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Provider Name | ALISON LEE GOETGELUCK DPT
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Gender | Female
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Dates
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Enumeration Date | 02/23/2011
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Last Update Date | 10/14/2014
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Provider Practice Location Address
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Address Line | 1435 W ADDISON ST APT 2
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City | CHICAGO
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State | IL
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Zip | 60613-4375
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Country | US
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Telephone | 847-723-4532
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Fax | 847-723-4353
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Provider Business Mailing Address
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Address Line | 1435 W ADDISON ST APT 2
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City | CHICAGO
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State | IL
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Zip | 60613-4375
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Country | US
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Telephone | 248-231-0759
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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 | 225100000X
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Taxonomy Name | Physical Therapist
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License Number | 5501015495
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License Number State | MI
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Taxonomy #2
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Taxonomy Code | 225100000X
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Taxonomy Name | Physical Therapist
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License Number | 070019795
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License Number State | IL
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