Basic Information
| Provider Information | |||||||||
| NPI: | 1164460341 | ||||||||
| EntityType: | 1 | ||||||||
| ReplacementNPI: | |||||||||
| OrganizationName: | |||||||||
| LastName: | GOETZ | ||||||||
| FirstName: | CHRISTOPHER | ||||||||
| MiddleName: | AARON | ||||||||
| NamePrefix: | MR. | ||||||||
| NameSuffix: | |||||||||
| Credential: | PT | ||||||||
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| Mailing Information | |||||||||
| Address1: | 2 W 10TH ST | ||||||||
| Address2: | |||||||||
| City: | MARCUS HOOK | ||||||||
| State: | PA | ||||||||
| PostalCode: | 190614513 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 6108598850 | ||||||||
| FaxNumber: | 6108597876 | ||||||||
| Practice Location | |||||||||
| Address1: | 1651-53 PULASKI HIGHWAY | ||||||||
| Address2: | |||||||||
| City: | BEAR | ||||||||
| State: | DE | ||||||||
| PostalCode: | 197011453 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 3028341550 | ||||||||
| FaxNumber: | 3028341549 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 06/02/2006 | ||||||||
| LastUpdateDate: | 06/14/2010 | ||||||||
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| ProviderGenderCode: | M | ||||||||
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| IsSoleProprietor: | N | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 225100000X | J1-0001620 | DE | Y | Respiratory, Developmental, Rehabilitative and Restorative Service Providers | Physical Therapist | 225100000X | PT015446 | PA | N | Respiratory, Developmental, Rehabilitative and Restorative Service Providers | Physical Therapist |
ID Information
| ID | Type | State | Issuer | Description | 057805VLZ | 01 | PA | MEDICARE | OTHER | 1164460341 | 05 | DE | MEDICAID | 1386530 | 01 | HIGHMARK PABS | OTHER | 30071081 | 01 | PA | KEYSTONE MERCY | OTHER | 1164460341 | 01 | DE | DPCI | OTHER | P00692894 | 01 | RAILROAD | OTHER | 2076609000 | 01 | IBC | OTHER | P00160856 | 01 | DE | RAILROAD MEDICARE | OTHER | 102404710-0001 | 05 | PA | MEDICAID | 021749D48 | 01 | DE | MEDICARE | OTHER |