Provider Demographics
NPI:1962068130
Name:GOECKERMAN, AMANDA JUNE (PT, DPT)
Entity type:Individual
Prefix:
First Name:AMANDA
Middle Name:JUNE
Last Name:GOECKERMAN
Suffix:
Gender:F
Credentials:PT, DPT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1121 CARDINAL BAY DR
Mailing Address - Street 2:
Mailing Address - City:OREGON
Mailing Address - State:OH
Mailing Address - Zip Code:43616-3483
Mailing Address - Country:US
Mailing Address - Phone:419-367-8319
Mailing Address - Fax:
Practice Address - Street 1:2815 DUSTIN RD
Practice Address - Street 2:
Practice Address - City:OREGON
Practice Address - State:OH
Practice Address - Zip Code:43616-3495
Practice Address - Country:US
Practice Address - Phone:419-693-0676
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2019-05-14
Last Update Date:2019-05-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OHPT018017225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist