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NPI Code Detail

MEDICARE: MR. ALBERT STEVEN GOFFINETT II ATC

MEDICARE: MR. ALBERT STEVEN GOFFINETT II ATC
Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

# Taxonomy Code Taxonomy License Number License Number State
1174400000XSpecialistAT 000812OH

General Provider Information

NPI Number : 1861469116
Entity Type Code : Individual
Provider Name (Legal Business Name) : MR. ALBERT STEVEN GOFFINETT II ATC
Provider Business Mailing Address
First Line : 1436 BIRCH BARK CT
Second Line :
City : DAYTON
State : OH
Zip : 45440-4053
Country : US
Telephone Number : 937-848-9294
Fax Number :
Provider Business Practice Location Address
First Line : 1997 MIAMISBURG CENTERVILLE RD
Second Line :
City : DAYTON
State : OH
Zip : 45459-3811
Country : US
Telephone Number : 937-439-6109
Fax Number : 937-439-6240
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 03/07/2006
Last Update Date : 07/01/2009

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