Provider Demographics
NPI:1487493284
Name:GOFF, JACOB A
Entity type:Individual
Prefix:
First Name:JACOB
Middle Name:A
Last Name:GOFF
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1203 US HIGHWAY 98 STE 1C
Mailing Address - Street 2:
Mailing Address - City:DAPHNE
Mailing Address - State:AL
Mailing Address - Zip Code:36526-4255
Mailing Address - Country:US
Mailing Address - Phone:251-626-7778
Mailing Address - Fax:251-626-7780
Practice Address - Street 1:1203 US HIGHWAY 98 STE 1C
Practice Address - Street 2:
Practice Address - City:DAPHNE
Practice Address - State:AL
Practice Address - Zip Code:36526-4255
Practice Address - Country:US
Practice Address - Phone:251-626-7778
Practice Address - Fax:251-626-7780
Is Sole Proprietor?:No
Enumeration Date:2024-05-21
Last Update Date:2024-05-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist