Provider Demographics
NPI:1023607678
Name:GOETTEL, NICHOLAS S (PT)
Entity type:Individual
Prefix:
First Name:NICHOLAS
Middle Name:S
Last Name:GOETTEL
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 1:1928 STAR BATT DR STE A
Mailing Address - Street 2:
Mailing Address - City:ROCHESTER HILLS
Mailing Address - State:MI
Mailing Address - Zip Code:48309-3722
Mailing Address - Country:US
Mailing Address - Phone:248-289-1168
Mailing Address - Fax:
Practice Address - Street 1:1928 STAR BATT DR STE A
Practice Address - Street 2:
Practice Address - City:ROCHESTER HILLS
Practice Address - State:MI
Practice Address - Zip Code:48309-3722
Practice Address - Country:US
Practice Address - Phone:248-289-1168
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2021-01-18
Last Update Date:2022-12-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist