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NPI Code Detail

MEDICARE: JOHN GOETZE PHYSICAL THERAPY, INC

MEDICARE: JOHN GOETZE PHYSICAL THERAPY, INC
Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

# Taxonomy Code Taxonomy License Number License Number State
1225100000XPhysical Therapist

Other Identifiers

# Provider Identifier Provider Identifier Type Provider Identifier State Provider Identifier Issuer
1Y920COTHERFLBCBS

General Provider Information

NPI Number : 1700956471
Entity Type Code : Organization
Provider Name (Legal Business Name) : JOHN GOETZE PHYSICAL THERAPY, INC
Provider Business Mailing Address
First Line : PO BOX 8847
Second Line :
City : FLEMING ISLAND
State : FL
Zip : 32006-0019
Country : US
Telephone Number :
Fax Number :
Provider Business Practice Location Address
First Line : 2004 UNIVERSITY BLVD W
Second Line :
City : JACKSONVILLE
State : FL
Zip : 32217-2016
Country : US
Telephone Number : 904-421-2119
Fax Number :
Authorized Official
Title or Position : OWNER
Name : JOHN GOETZE
Credential :
Telephone Number : 904-421-2119
Provider Enumeration Date : 11/09/2006
Last Update Date : 07/25/2007

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Directions to “JOHN GOETZE PHYSICAL THERAPY, INC ” Practice Location

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