Provider Demographics
NPI:1144344367
Name:GOFF, HEATHER JOHNSON (PTA)
Entity type:Individual
Prefix:MRS
First Name:HEATHER
Middle Name:JOHNSON
Last Name:GOFF
Suffix:
Gender:F
Credentials:PTA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1201 N BREWINGTON RD
Mailing Address - Street 2:
Mailing Address - City:MANNING
Mailing Address - State:SC
Mailing Address - Zip Code:29102-7330
Mailing Address - Country:US
Mailing Address - Phone:803-473-5593
Mailing Address - Fax:
Practice Address - Street 1:122 NORTH BROOKS STREET
Practice Address - Street 2:
Practice Address - City:MANNING
Practice Address - State:SC
Practice Address - Zip Code:29102
Practice Address - Country:US
Practice Address - Phone:803-433-9001
Practice Address - Fax:803-433-9002
Is Sole Proprietor?:No
Enumeration Date:2007-03-16
Last Update Date:2013-09-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
SC1236225200000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225200000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapy Assistant