NPIMap

Organization Active NPI

Southern Lakes Therapy LLC

  • Physical Therapist
  • Manning, SC
National Provider Identifier
1700212420
Registry record updated Aug 12, 2025
On this page

Key facts

NPPES NPI Registry
Primary specialty
Physical TherapistTaxonomy code 225100000X
License
5485 Issued in SC
Legal business name
SOUTHERN LAKES THERAPY LLC
Practice address
297 W Boyce St
Manning, SC 29102
Phone
(803) 433-9001
Fax
(803) 433-9001
NPI assigned
Sep 26, 2013
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Aug 12, 2025

Registry information is reported by the provider to CMS and is not verified. About this source

Authorized official

Name
Heather Johnson GoffNPI 1144344367
Title
Coowner
Phone
(803) 433-9001

Authorized official NPPES reports the official by name only. The link goes to the one practitioner connected to this organization with that name.

Specialties & licenses 5

Specialty (taxonomy)CodeLicenseStatePrimary
Physical TherapistGroup: 193200000X MULTI-SPECIALTY GROUP 225100000X 5485 SC Primary
Physical TherapistGroup: 193200000X MULTI-SPECIALTY GROUP 225100000X 4166 SC
Physical Therapy AssistantGroup: 193200000X MULTI-SPECIALTY GROUP 225200000X 1236 SC
Occupational TherapistGroup: 193200000X MULTI-SPECIALTY GROUP 225X00000X
Speech-Language PathologistGroup: 193200000X MULTI-SPECIALTY GROUP 235Z00000X

Addresses

Primary practice location

297 W Boyce St
Manning, SC 29102

Mailing address

297 W Boyce St
Manning, SC 29102-3004
Phone (803) 433-9001

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in SC

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
O20140113000282 SC Part B Supplier - Physical/Occupational Therapy Group in Private Practice 3779711031 Receives reassigned benefits from 5 practitioners
Practice locations: Manning, SC

National Provider Directory

National Provider Directory

Locations

297 W Boyce St
Manning, SC 29102
Phone (803) 433-9001

Practitioners & affiliated clinicians

Practitioners 10

Individual providers connected to this organization through Medicare benefit reassignment, Care Compare group membership or National Provider Directory roles.

NPI Registry JSON

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1380153600000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1754956800000",
    "number": "1700212420",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "297 W BOYCE ST",
            "city": "MANNING",
            "state": "SC",
            "postal_code": "291023004",
            "telephone_number": "803-433-9001"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "297 W BOYCE ST",
            "city": "MANNING",
            "state": "SC",
            "postal_code": "29102",
            "telephone_number": "803-433-9001",
            "fax_number": "803-433-9001"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "SOUTHERN LAKES THERAPY LLC",
        "organizational_subpart": "NO",
        "enumeration_date": "2013-09-26",
        "last_updated": "2025-08-12",
        "certification_date": "2025-08-12",
        "status": "A",
        "authorized_official_last_name": "GOFF",
        "authorized_official_first_name": "HEATHER",
        "authorized_official_middle_name": "JOHNSON",
        "authorized_official_title_or_position": "COOWNER",
        "authorized_official_telephone_number": "803-433-9001"
    },
    "taxonomies": [
        {
            "code": "225100000X",
            "taxonomy_group": "193200000X MULTI-SPECIALTY GROUP",
            "desc": "Physical Therapist",
            "state": "SC",
            "license": "5485",
            "primary": true
        },
        {
            "code": "225100000X",
            "taxonomy_group": "193200000X MULTI-SPECIALTY GROUP",
            "desc": "Physical Therapist",
            "state": "SC",
            "license": "4166",
            "primary": false
        },
        {
            "code": "225200000X",
            "taxonomy_group": "193200000X MULTI-SPECIALTY GROUP",
            "desc": "Physical Therapy Assistant",
            "state": "SC",
            "license": "1236",
            "primary": false
        },
        {
            "code": "225X00000X",
            "taxonomy_group": "193200000X MULTI-SPECIALTY GROUP",
            "desc": "Occupational Therapist",
            "state": null,
            "license": null,
            "primary": false
        },
        {
            "code": "235Z00000X",
            "taxonomy_group": "193200000X MULTI-SPECIALTY GROUP",
            "desc": "Speech-Language Pathologist",
            "state": null,
            "license": null,
            "primary": false
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Manning, SC

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Aug 12, 2025; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
  • Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments.
  • National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.