Provider Demographics
NPI:1770938854
Name:GOCHETT, MARCUS
Entity type:Individual
Prefix:
First Name:MARCUS
Middle Name:
Last Name:GOCHETT
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:234 SHORELINE DR
Mailing Address - Street 2:
Mailing Address - City:COLUMBIA
Mailing Address - State:SC
Mailing Address - Zip Code:29212-8022
Mailing Address - Country:US
Mailing Address - Phone:803-463-0377
Mailing Address - Fax:
Practice Address - Street 1:234 SHORELINE DR
Practice Address - Street 2:
Practice Address - City:COLUMBIA
Practice Address - State:SC
Practice Address - Zip Code:29212-8022
Practice Address - Country:US
Practice Address - Phone:803-463-0377
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2016-04-26
Last Update Date:2016-04-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
SC7001175F00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes175F00000XOther Service ProvidersNaturopath
Provider Identifiers
StateIdentifier IDID TypeIssuer
SC7001OtherMASSAGE THERAPY