Provider Demographics
NPI:1508864224
Name:GOFF, TRACEY D (MPT)
Entity Type:Individual
Prefix:MRS
First Name:TRACEY
Middle Name:D
Last Name:GOFF
Suffix:
Gender:F
Credentials:MPT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1418 S STATE ST
Mailing Address - Street 2:
Mailing Address - City:DOVER
Mailing Address - State:DE
Mailing Address - Zip Code:19901-4948
Mailing Address - Country:US
Mailing Address - Phone:302-734-1515
Mailing Address - Fax:302-734-1591
Practice Address - Street 1:1418 S STATE ST
Practice Address - Street 2:
Practice Address - City:DOVER
Practice Address - State:DE
Practice Address - Zip Code:19901-4948
Practice Address - Country:US
Practice Address - Phone:302-734-1515
Practice Address - Fax:302-734-1515
Is Sole Proprietor?:No
Enumeration Date:2005-07-07
Last Update Date:2023-09-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
DEJ1-0001178225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist