Provider Demographics
NPI:1679883631
Name:GOETZ, ROSEMARY ELIZABETH (PTA)
Entity type:Individual
Prefix:MS
First Name:ROSEMARY
Middle Name:ELIZABETH
Last Name:GOETZ
Suffix:
Gender:F
Credentials:PTA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:21 CARRIAGE HL E
Mailing Address - Street 2:
Mailing Address - City:WILLIAMSVILLE
Mailing Address - State:NY
Mailing Address - Zip Code:14221-1537
Mailing Address - Country:US
Mailing Address - Phone:716-432-3514
Mailing Address - Fax:716-688-0955
Practice Address - Street 1:21 CARRIAGE HL E
Practice Address - Street 2:
Practice Address - City:WILLIAMSVILLE
Practice Address - State:NY
Practice Address - Zip Code:14221-1537
Practice Address - Country:US
Practice Address - Phone:716-432-3514
Practice Address - Fax:716-688-0955
Is Sole Proprietor?:No
Enumeration Date:2010-10-08
Last Update Date:2010-10-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY004273-1225200000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225200000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapy Assistant