Healthcare Provider Details

I. General information

NPI: 1144344367
Provider Name (Legal Business Name): HEATHER JOHNSON GOFF PTA
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 03/16/2007
Last Update Date: 08/11/2025
Certification Date: 08/11/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

297 W BOYCE ST
MANNING SC
29102-3004
US

IV. Provider business mailing address

1201 N BREWINGTON RD
MANNING SC
29102-7330
US

V. Phone/Fax

Practice location:
  • Phone: 803-433-9001
  • Fax: 803-433-9002
Mailing address:
  • Phone: 803-473-5593
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code225200000X
TaxonomyPhysical Therapy Assistant
License Number1236
License Number StateSC

VII. Legacy identifiers

For crosswalk purposes, the following legacy (non-NPI) identifiers are available for this provider:

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: