Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 2251N0400X | Physical Therapist - Neurology | PT23080 | CA |
NPI | 1255667671 |
---|---|
Provider Name | Spencer Goff |
First Address | San Diego, CA 92114-3400 |
Second Address | San Diego, CA 92114-3400 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 20/10/2009 |
Last Update Date | 20/10/2009 |