Provider Demographics
NPI:1235766098
Name:HOFFERT, TROY ALLEN
Entity Type:Individual
Prefix:
First Name:TROY
Middle Name:ALLEN
Last Name:HOFFERT
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:50 PINETREE CT
Mailing Address - Street 2:
Mailing Address - City:PALM HARBOR
Mailing Address - State:FL
Mailing Address - Zip Code:34683-2924
Mailing Address - Country:US
Mailing Address - Phone:215-360-4006
Mailing Address - Fax:
Practice Address - Street 1:651 N OLD COACHMAN RD
Practice Address - Street 2:
Practice Address - City:CLEARWATER
Practice Address - State:FL
Practice Address - Zip Code:33765-2321
Practice Address - Country:US
Practice Address - Phone:215-360-4006
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2020-03-23
Last Update Date:2020-03-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PART001834A2255A2300X
FLAL9352255A2300X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2255A2300XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersSpecialist/TechnologistAthletic Trainer