Provider Demographics
NPI:1902281140
Name:GOFORTH, MARY ELIZABETH (DPT)
Entity Type:Individual
Prefix:
First Name:MARY
Middle Name:ELIZABETH
Last Name:GOFORTH
Suffix:
Gender:F
Credentials:DPT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:6 MOUNTAIN TER
Mailing Address - Street 2:
Mailing Address - City:ASHEVILLE
Mailing Address - State:NC
Mailing Address - Zip Code:28806-1906
Mailing Address - Country:US
Mailing Address - Phone:828-799-0603
Mailing Address - Fax:
Practice Address - Street 1:1630 OLD CLYDE RD
Practice Address - Street 2:
Practice Address - City:CLYDE
Practice Address - State:NC
Practice Address - Zip Code:28721-8591
Practice Address - Country:US
Practice Address - Phone:828-565-0286
Practice Address - Fax:833-488-1895
Is Sole Proprietor?:Yes
Enumeration Date:2015-07-29
Last Update Date:2023-12-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NCP15833225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist