Provider Demographics
NPI:1376868919
Name:GOETZ, MARY E (PT)
Entity Type:Individual
Prefix:
First Name:MARY
Middle Name:E
Last Name:GOETZ
Suffix:
Gender:F
Credentials:PT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:23716 NE CANYON LOOP RD
Mailing Address - Street 2:
Mailing Address - City:BATTLE GROUND
Mailing Address - State:WA
Mailing Address - Zip Code:98604-5060
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:12214 SE MILL PLAIN BLVD
Practice Address - Street 2:#101
Practice Address - City:VANCOUVER
Practice Address - State:WA
Practice Address - Zip Code:98684-6019
Practice Address - Country:US
Practice Address - Phone:360-254-4040
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2010-04-06
Last Update Date:2010-04-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WAPT00005115172M00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes172M00000XOther Service ProvidersMechanotherapist