Provider Demographics
NPI:1386707529
Name:GOLDBECK, TODD G (DPT, ATC, CSCS, STC)
Entity type:Individual
Prefix:DR
First Name:TODD
Middle Name:G
Last Name:GOLDBECK
Suffix:
Gender:M
Credentials:DPT, ATC, CSCS, STC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:8261 STARR GRASS DR
Mailing Address - Street 2:
Mailing Address - City:MADISON
Mailing Address - State:WI
Mailing Address - Zip Code:53719-4471
Mailing Address - Country:US
Mailing Address - Phone:608-279-6960
Mailing Address - Fax:866-401-0083
Practice Address - Street 1:1515 HIGHWAY 26 SOUTH
Practice Address - Street 2:
Practice Address - City:JEFFERSON
Practice Address - State:WI
Practice Address - Zip Code:53549
Practice Address - Country:US
Practice Address - Phone:608-279-6960
Practice Address - Fax:866-401-0083
Is Sole Proprietor?:No
Enumeration Date:2006-12-19
Last Update Date:2025-09-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WI6214-024225100000X, 2251S0007X, 2251X0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist
No2251S0007XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical TherapistSports
No2251X0800XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical TherapistOrthopedic