Provider Demographics
NPI:1669219580
Name:GOERTZEN, BARBARA
Entity type:Individual
Prefix:
First Name:BARBARA
Middle Name:
Last Name:GOERTZEN
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:10225 AUSTIN DR STE 106
Mailing Address - Street 2:
Mailing Address - City:SPRING VALLEY
Mailing Address - State:CA
Mailing Address - Zip Code:91978-1521
Mailing Address - Country:US
Mailing Address - Phone:619-660-8895
Mailing Address - Fax:619-660-8697
Practice Address - Street 1:10225 AUSTIN DR STE 106
Practice Address - Street 2:
Practice Address - City:SPRING VALLEY
Practice Address - State:CA
Practice Address - Zip Code:91978-1521
Practice Address - Country:US
Practice Address - Phone:619-660-8895
Practice Address - Fax:619-660-8697
Is Sole Proprietor?:No
Enumeration Date:2024-07-09
Last Update Date:2024-07-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA6202225200000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225200000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapy Assistant