Provider Demographics
NPI:1912363201
Name:GOFF, HEATHER (PTA)
Entity Type:Individual
Prefix:MS
First Name:HEATHER
Middle Name:
Last Name:GOFF
Suffix:
Gender:F
Credentials:PTA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:204 W NORWAY ST
Mailing Address - Street 2:
Mailing Address - City:HARRISON
Mailing Address - State:MI
Mailing Address - Zip Code:48625-2542
Mailing Address - Country:US
Mailing Address - Phone:559-676-8066
Mailing Address - Fax:
Practice Address - Street 1:220 S HUGHSTON ST
Practice Address - Street 2:
Practice Address - City:MC BAIN
Practice Address - State:MI
Practice Address - Zip Code:49657-9622
Practice Address - Country:US
Practice Address - Phone:231-825-2990
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2016-01-03
Last Update Date:2024-03-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AZ10811A225200000X
MI5502007965225200000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225200000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapy Assistant