Provider Demographics
NPI:1245298975
Name:GOFF, HEIDI (PT)
Entity type:Individual
Prefix:
First Name:HEIDI
Middle Name:
Last Name:GOFF
Suffix:
Gender:F
Credentials:PT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:114 AVERY LAKE DR
Mailing Address - Street 2:
Mailing Address - City:WINTER SPRINGS
Mailing Address - State:FL
Mailing Address - Zip Code:32708-5186
Mailing Address - Country:US
Mailing Address - Phone:407-312-4133
Mailing Address - Fax:877-980-1981
Practice Address - Street 1:114 AVERY LAKE DR
Practice Address - Street 2:
Practice Address - City:WINTER SPRINGS
Practice Address - State:FL
Practice Address - Zip Code:32708-5186
Practice Address - Country:US
Practice Address - Phone:407-312-4133
Practice Address - Fax:877-980-1981
Is Sole Proprietor?:No
Enumeration Date:2006-05-02
Last Update Date:2016-09-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLPT 16192204C00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes204C00000XAllopathic & Osteopathic PhysiciansNeuromusculoskeletal Medicine, Sports Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL681637196Medicaid
FL886448900Medicaid