Organization
SOUTHERN LAKES THERAPY LLC
Active
Organization subpart
No
Provider details
NPI number
Authorized official
HEATHER JOHNSON GOFF (COOWNER)
(803) 433-9001
Entity
Organization
Contact information
Practice address
297 W BOYCE ST, MANNING, SC 29102
(803) 433-9001
(803) 433-9001
Mailing address
297 W BOYCE ST, MANNING, SC 29102-3004
(803) 433-9001
Taxonomy
Speciality
Code
Description
License number
State
225100000X
Physical Therapist
4166
SC
225100000X
Physical Therapist
Primary
5485
SC
225200000X
Physical Therapy Assistant
1236
SC
225X00000X
Occupational Therapist
—
—
235Z00000X
Speech-Language Pathologist
—
—
Other
Enumeration date
09/26/2013
Last updated
08/12/2025
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