Individual provider Active NPI

Christine Marie Goetsch, PTA

  • Physical Therapy Assistant
  • Chilton, WI
National Provider Identifier
1821245465
Registry record updated Aug 26, 2008
On this page

Key facts

NPPES NPI Registry
Primary specialty
Physical Therapy AssistantTaxonomy code 225200000X
License
263-019 Issued in WI
Practice address
614 Memorial Dr
Chilton, WI 53014-1568
Phone
(920) 849-7508
Fax
(920) 849-1811
NPI assigned
Aug 26, 2008
Sex
Female
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on Aug 26, 2008

Registry information is reported by the provider to CMS and is not verified. About this source

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Physical Therapy Assistant 225200000X 263-019 WI Primary

Addresses

Primary practice location

614 Memorial Dr
Chilton, WI 53014-1568

Mailing address

W2809 E Jefferson Rd
Chilton, WI 53014-9670
Phone (920) 849-3259

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Not listed in the public Medicare enrollment file

National Provider Directory

National Provider Directory
Medicare enrollment (NPD)
Not enrolled

State licenses

LicenseStateTypeSpecialty
263-019WIMDPhysical Therapy Assistant

NPI Registry JSON

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1219708800000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1219708800000",
    "number": "1821245465",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "W2809 E JEFFERSON RD",
            "city": "CHILTON",
            "state": "WI",
            "postal_code": "530149670",
            "telephone_number": "920-849-3259"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "614 MEMORIAL DR",
            "city": "CHILTON",
            "state": "WI",
            "postal_code": "530141568",
            "telephone_number": "920-849-7508",
            "fax_number": "920-849-1811"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "GOETSCH",
        "first_name": "CHRISTINE",
        "middle_name": "MARIE",
        "name_prefix": "Mrs.",
        "credential": "PTA",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2008-08-26",
        "last_updated": "2008-08-26",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "225200000X",
            "taxonomy_group": "",
            "desc": "Physical Therapy Assistant",
            "state": "WI",
            "license": "263-019",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Chilton, WI

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Aug 26, 2008; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
  • National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.