Provider Demographics
NPI:1548204068
Name:GOETSCH, RONALD DAVID (AT,C)
Entity Type:Individual
Prefix:
First Name:RONALD
Middle Name:DAVID
Last Name:GOETSCH
Suffix:
Gender:M
Credentials:AT,C
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:402 WAVERLY TER
Mailing Address - Street 2:
Mailing Address - City:RUTLEDGE
Mailing Address - State:PA
Mailing Address - Zip Code:19070-2138
Mailing Address - Country:US
Mailing Address - Phone:610-543-0775
Mailing Address - Fax:
Practice Address - Street 1:217 KEDRON AVE
Practice Address - Street 2:
Practice Address - City:FOLSOM
Practice Address - State:PA
Practice Address - Zip Code:19033-1310
Practice Address - Country:US
Practice Address - Phone:610-532-2633
Practice Address - Fax:610-532-7856
Is Sole Proprietor?:Not Answered
Enumeration Date:2006-06-15
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PATE000997L225200000X
PART000032A2255A2300X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Not Answered225200000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapy Assistant
Not Answered2255A2300XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersSpecialist/TechnologistAthletic Trainer