# SOUTHERN LAKES THERAPY LLC

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- **Entity:** Organization
- **Status:** Active
- **Organization subpart:** No

## Provider details

- **NPI number:** 1700212420
- **Authorized official:** HEATHER JOHNSON GOFF (COOWNER)
- **Authorized official phone:** (803) 433-9001

## Contact information

- **Practice address:** 297 W BOYCE ST, MANNING, SC 29102
- **Practice address phone:** (803) 433-9001
- **Practice address fax:** (803) 433-9001
- **Mailing address:** 297 W BOYCE ST, MANNING, SC 29102-3004
- **Mailing address phone:** (803) 433-9001

## Taxonomy

| Code | Description | License number | State | Primary |
| --- | --- | --- | --- | --- |
| 225100000X | Physical Therapist | 4166 | SC | — |
| 225100000X | Physical Therapist | 5485 | SC | Yes |
| 225200000X | Physical Therapy Assistant | 1236 | SC | — |
| 225X00000X | Occupational Therapist | — | NULL | — |
| 225X00000X | Occupational Therapist | — | — | — |
| 235Z00000X | Speech-Language Pathologist | — | NULL | — |
| 235Z00000X | Speech-Language Pathologist | — | — | — |

## Other

- **Enumeration date:** 09/26/2013
- **Last updated:** 08/12/2025