Provider Demographics
NPI:1386707529
Name:GOLDBECK, TODD G (DPT, ATC, CSCS, STC)
Entity type:Individual
Prefix:DR
First Name:TODD
Middle Name:G
Last Name:GOLDBECK
Suffix:
Gender:M
Credentials:DPT, ATC, CSCS, STC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:8261 STARR GRASS DR
Mailing Address - Street 2:
Mailing Address - City:MADISON
Mailing Address - State:WI
Mailing Address - Zip Code:53719-4471
Mailing Address - Country:US
Mailing Address - Phone:608-279-6960
Mailing Address - Fax:866-401-0083
Practice Address - Street 1:1515 HIGHWAY 26 SOUTH
Practice Address - Street 2:
Practice Address - City:JEFFERSON
Practice Address - State:WI
Practice Address - Zip Code:53549
Practice Address - Country:US
Practice Address - Phone:608-279-6960
Practice Address - Fax:866-401-0083
Is Sole Proprietor?:No
Enumeration Date:2006-12-19
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WI6214-024225100000X, 2251S0007X, 2251X0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Not Answered225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist
Not Answered2251S0007XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical TherapistSports
Not Answered2251X0800XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical TherapistOrthopedic