Provider Demographics
NPI:1912798414
Name:GOOCH, DILLON (DPT)
Entity type:Individual
Prefix:
First Name:DILLON
Middle Name:
Last Name:GOOCH
Suffix:
Gender:M
Credentials:DPT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:203 EVANS RD
Mailing Address - Street 2:
Mailing Address - City:MILNER
Mailing Address - State:GA
Mailing Address - Zip Code:30257-3107
Mailing Address - Country:US
Mailing Address - Phone:912-536-8533
Mailing Address - Fax:
Practice Address - Street 1:522 N CENTER ST
Practice Address - Street 2:
Practice Address - City:THOMASTON
Practice Address - State:GA
Practice Address - Zip Code:30286-3695
Practice Address - Country:US
Practice Address - Phone:706-646-4371
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2025-05-14
Last Update Date:2025-05-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GA225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist