Healthcare Provider Details

I. General information

NPI: 1053242545
Provider Name (Legal Business Name): PAUL WAYNE GOFF JR.
Entity Type: Individual
Gender: Male
Sole Proprietor: N

Provider Other Name: PJ GOFF

II. Dates (important events)

Enumeration Date: 05/26/2026
Last Update Date: 05/26/2026
Certification Date: 05/26/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3300 N RUNNING CREEK WAY STE 150
LEHI UT
84043-5563
US

IV. Provider business mailing address

3300 N RUNNING CREEK WAY STE 150
LEHI UT
84043-5563
US

V. Phone/Fax

Practice location:
  • Phone: 385-336-5303
  • Fax:
Mailing address:
  • Phone: 385-336-5303
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code225100000X
TaxonomyPhysical Therapist
License Number14267827-2401
License Number StateUT

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: