Provider Demographics
NPI:1851499222
Name:GOEHNER, AMY MARIE (PT)
Entity Type:Individual
Prefix:
First Name:AMY
Middle Name:MARIE
Last Name:GOEHNER
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 1:20810 ODELL CT N
Mailing Address - Street 2:
Mailing Address - City:SCANDIA
Mailing Address - State:MN
Mailing Address - Zip Code:55073-6400
Mailing Address - Country:US
Mailing Address - Phone:612-718-2669
Mailing Address - Fax:651-927-0450
Practice Address - Street 1:168 LAKE ST S STE C
Practice Address - Street 2:
Practice Address - City:FOREST LAKE
Practice Address - State:MN
Practice Address - Zip Code:55025-2676
Practice Address - Country:US
Practice Address - Phone:612-718-2669
Practice Address - Fax:651-927-0450
Is Sole Proprietor?:No
Enumeration Date:2006-09-20
Last Update Date:2021-01-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MN6611225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist
Provider Identifiers
StateIdentifier IDID TypeIssuer
MN282PIGOOtherBCBS
MN246599Medicare ID - Type Unspecified