Provider Demographics
NPI:1629831151
Name:GOFORTH-DENT, CATHERINE (ACSM-CEP)
Entity Type:Individual
Prefix:MS
First Name:CATHERINE
Middle Name:
Last Name:GOFORTH-DENT
Suffix:
Gender:F
Credentials:ACSM-CEP
Other - Prefix:MISS
Other - First Name:CATHERINE
Other - Middle Name:
Other - Last Name:SWEDLUND
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:ACSM-CEP
Mailing Address - Street 1:3640 HIGH ST STE 2D
Mailing Address - Street 2:
Mailing Address - City:PORTSMOUTH
Mailing Address - State:VA
Mailing Address - Zip Code:23707-3213
Mailing Address - Country:US
Mailing Address - Phone:325-280-2013
Mailing Address - Fax:757-398-9281
Practice Address - Street 1:3640 HIGH ST STE 2D
Practice Address - Street 2:
Practice Address - City:PORTSMOUTH
Practice Address - State:VA
Practice Address - Zip Code:23707-3213
Practice Address - Country:US
Practice Address - Phone:325-280-2013
Practice Address - Fax:757-398-9281
Is Sole Proprietor?:No
Enumeration Date:2024-02-06
Last Update Date:2024-02-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
919938224Y00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes224Y00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersClinical Exercise Physiologist
Provider Identifiers
StateIdentifier IDID TypeIssuer
919938OtherAMERICAN COLLEGE OF SPORTS MEDICINE