Healthcare Provider Details

I. General information

NPI: 1245298975
Provider Name (Legal Business Name): HEIDI GOFF PT
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 05/02/2006
Last Update Date: 09/13/2016
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

114 AVERY LAKE DR
WINTER SPRINGS FL
32708-5186
US

IV. Provider business mailing address

114 AVERY LAKE DR
WINTER SPRINGS FL
32708-5186
US

V. Phone/Fax

Practice location:
  • Phone: 407-312-4133
  • Fax: 877-980-1981
Mailing address:
  • Phone: 407-312-4133
  • Fax: 877-980-1981

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code204C00000X
TaxonomySports Medicine (Neuromusculoskeletal Medicine) Physician
License NumberPT 16192
License Number StateFL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: