Provider Demographics
NPI:1841822012
Name:GOETZ, JACQUELINE MCCLENEGHEN (DPT)
Entity type:Individual
Prefix:DR
First Name:JACQUELINE
Middle Name:MCCLENEGHEN
Last Name:GOETZ
Suffix:
Gender:F
Credentials:DPT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:14501 MONTFORT DR APT 920
Mailing Address - Street 2:
Mailing Address - City:DALLAS
Mailing Address - State:TX
Mailing Address - Zip Code:75254-8555
Mailing Address - Country:US
Mailing Address - Phone:214-558-0005
Mailing Address - Fax:
Practice Address - Street 1:7701 LAS COLINAS RDG STE 110
Practice Address - Street 2:
Practice Address - City:IRVING
Practice Address - State:TX
Practice Address - Zip Code:75063-7552
Practice Address - Country:US
Practice Address - Phone:214-574-7848
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2020-02-06
Last Update Date:2020-02-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX1327970225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist