Provider Demographics
NPI:1164460341
Name:GOETZ, CHRISTOPHER AARON (PT)
Entity type:Individual
Prefix:MR
First Name:CHRISTOPHER
Middle Name:AARON
Last Name:GOETZ
Suffix:
Gender:M
Credentials:PT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2 W 10TH ST
Mailing Address - Street 2:
Mailing Address - City:MARCUS HOOK
Mailing Address - State:PA
Mailing Address - Zip Code:19061-4513
Mailing Address - Country:US
Mailing Address - Phone:610-859-8850
Mailing Address - Fax:610-859-7876
Practice Address - Street 1:1651-53 PULASKI HIGHWAY
Practice Address - Street 2:
Practice Address - City:BEAR
Practice Address - State:DE
Practice Address - Zip Code:19701-1453
Practice Address - Country:US
Practice Address - Phone:302-834-1550
Practice Address - Fax:302-834-1549
Is Sole Proprietor?:No
Enumeration Date:2006-06-02
Last Update Date:2010-06-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
DEJ1-0001620225100000X
PAPT015446225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist
Provider Identifiers
StateIdentifier IDID TypeIssuer
PA057805VLZOtherMEDICARE
DE1164460341Medicaid
1386530OtherHIGHMARK PABS
PA30071081OtherKEYSTONE MERCY
DE1164460341OtherDPCI
P00692894OtherRAILROAD
2076609000OtherIBC
DEP00160856OtherRAILROAD MEDICARE
PA102404710-0001Medicaid
DE021749D48OtherMEDICARE
P58509Medicare UPIN
PA102404710-0001Medicaid
DE1164460341Medicaid