Provider Demographics
NPI:1851441844
Name:WISSE-GOETZ, JANE E (MSPT)
Entity type:Individual
Prefix:MRS
First Name:JANE
Middle Name:E
Last Name:WISSE-GOETZ
Suffix:
Gender:F
Credentials:MSPT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2517 7TH AVE S
Mailing Address - Street 2:SUITE A-1
Mailing Address - City:GREAT FALLS
Mailing Address - State:MT
Mailing Address - Zip Code:59405-3032
Mailing Address - Country:US
Mailing Address - Phone:406-771-0777
Mailing Address - Fax:406-771-0776
Practice Address - Street 1:2517 7TH AVE S
Practice Address - Street 2:SUITE A-1
Practice Address - City:GREAT FALLS
Practice Address - State:MT
Practice Address - Zip Code:59405-3032
Practice Address - Country:US
Practice Address - Phone:406-771-0777
Practice Address - Fax:406-771-0776
Is Sole Proprietor?:No
Enumeration Date:2007-01-11
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MT207PT225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist
Provider Identifiers
StateIdentifier IDID TypeIssuer
MTP00096023OtherRAILROAD MEDICARE
MT3400553Medicaid