Provider Demographics
NPI:1326090143
Name:GOFFIN, WAYNE ARTHUR I
Entity Type:Individual
Prefix:
First Name:WAYNE
Middle Name:ARTHUR
Last Name:GOFFIN
Suffix:I
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:17751 MURDOCK CIR
Mailing Address - Street 2:
Mailing Address - City:PORT CHARLOTTE
Mailing Address - State:FL
Mailing Address - Zip Code:33948-1034
Mailing Address - Country:US
Mailing Address - Phone:941-743-8700
Mailing Address - Fax:941-743-8850
Practice Address - Street 1:17751 MURDOCK CIR
Practice Address - Street 2:
Practice Address - City:PORT CHARLOTTE
Practice Address - State:FL
Practice Address - Zip Code:33948-1034
Practice Address - Country:US
Practice Address - Phone:941-743-8700
Practice Address - Fax:941-743-8850
Is Sole Proprietor?:No
Enumeration Date:2006-05-17
Last Update Date:2010-08-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLPT 79202251X0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2251X0800XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical TherapistOrthopedic
Provider Identifiers
StateIdentifier IDID TypeIssuer
FLY911KOtherBC/BS
FLY911KOtherBC/BS