Provider Demographics
NPI:1255667671
Name:GOFF, SPENCER (PT)
Entity Type:Individual
Prefix:
First Name:SPENCER
Middle Name:
Last Name:GOFF
Suffix:
Gender:M
Credentials:PT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1277 GLENCOE DR
Mailing Address - Street 2:
Mailing Address - City:SAN DIEGO
Mailing Address - State:CA
Mailing Address - Zip Code:92114-3400
Mailing Address - Country:US
Mailing Address - Phone:619-248-5962
Mailing Address - Fax:619-462-0150
Practice Address - Street 1:1277 GLENCOE DR
Practice Address - Street 2:
Practice Address - City:SAN DIEGO
Practice Address - State:CA
Practice Address - Zip Code:92114-3400
Practice Address - Country:US
Practice Address - Phone:619-248-5962
Practice Address - Fax:619-462-0150
Is Sole Proprietor?:Yes
Enumeration Date:2009-10-20
Last Update Date:2009-10-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAPT230802251N0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2251N0400XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical TherapistNeurology