Healthcare Provider Details

I. General information

NPI: 1558623199
Provider Name (Legal Business Name): SAMUEL EDWARD GOFF PT, DPT
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 06/11/2012
Last Update Date: 06/11/2012
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1808 GADSDEN HWY SUITE 138
BIRMINGHAM AL
35235-3139
US

IV. Provider business mailing address

1808 GADSDEN HWY SUITE 138
BIRMINGHAM AL
35235-3139
US

V. Phone/Fax

Practice location:
  • Phone: 205-655-8866
  • Fax:
Mailing address:
  • Phone: 205-655-8866
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code2251X0800X
TaxonomyOrthopedic Physical Therapist
License Number
License Number State

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: