Southern Lakes Therapy LLC
NPI 1700212420ActiveOrganization· Physical Therapist· Manning, SC
Physical Therapist in Manning, South Carolina, registered in NPPES in September 2013. The authorized official on file is Heather Johnson Goff, Coowner. Enrolled in Medicare as part b supplier - physical/occupational therapy group in private practice.
Overview
| NPI | 1700212420 |
|---|---|
| Status | Active |
| Entity type | Organization |
| NPI issued | Sep 26, 2013 |
| Last updated in NPPES | Aug 12, 2025 |
| Certified by provider | Aug 12, 2025 |
Specialties and licenses
| Taxonomy | Code | License | State |
|---|---|---|---|
| Physical Therapist Primary | 225100000X | 5485 | SC |
| Physical Therapist | 225100000X | 4166 | SC |
| Physical Therapy Assistant | 225200000X | 1236 | SC |
| Occupational Therapist | 225X00000X | — | — |
| Speech-Language Pathologist | 235Z00000X | — | — |
Exclusion screening
| List | Result | Details |
|---|---|---|
| HHS-OIG LEIE · Oct 9, 2026 | No match | Checked by NPI and by name + state |
| North Carolina Medicaid · Nov 10, 2026 | No match | — |
| New York OMIG · Nov 10, 2026 | No match | — |
| Ohio Medicaid · Nov 10, 2026 | No match | — |
| Pennsylvania Medicheck · Nov 10, 2026 | No match | — |
| Washington HCA · Nov 10, 2026 | No match | — |
Official OIG search · How matching works ·Bulk check a roster
Medicare
| Enrollment (PECOS) | Enrolled Part B Supplier - Physical/Occupational Therapy Group in Private Practice (SC) |
|---|
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