Provider Demographics
NPI:1679687552
Name:GOFFAR, STEPHEN LAWRENCE (PT)
Entity Type:Individual
Prefix:DR
First Name:STEPHEN
Middle Name:LAWRENCE
Last Name:GOFFAR
Suffix:
Gender:M
Credentials:PT
Other - Prefix:
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Mailing Address - Street 1:2500 HEMINGWAY TRL
Mailing Address - Street 2:
Mailing Address - City:SCHERTZ
Mailing Address - State:TX
Mailing Address - Zip Code:78154-1145
Mailing Address - Country:US
Mailing Address - Phone:210-354-7882
Mailing Address - Fax:210-221-7585
Practice Address - Street 1:3851 ROGER BROOKE DR
Practice Address - Street 2:
Practice Address - City:FORT SAM HOUSTON
Practice Address - State:TX
Practice Address - Zip Code:78234-4501
Practice Address - Country:US
Practice Address - Phone:210-221-7513
Practice Address - Fax:210-221-7585
Is Sole Proprietor?:No
Enumeration Date:2006-08-18
Last Update Date:2007-07-08
Deactivation Date:
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Provider Licenses
StateLicense IDTaxonomies
HI1614225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist