Provider Demographics
NPI:1245429992
Name:HOFFMAN PHYSICAL THERAPY, LLC
Entity Type:Organization
Organization Name:HOFFMAN PHYSICAL THERAPY, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER/PHYSICAL THERAPIST
Authorized Official - Prefix:
Authorized Official - First Name:ADAM
Authorized Official - Middle Name:M
Authorized Official - Last Name:HOFFMAN
Authorized Official - Suffix:
Authorized Official - Credentials:PT
Authorized Official - Phone:386-304-8112
Mailing Address - Street 1:5100 S CLYDE MORRIS BLVD
Mailing Address - Street 2:SUITE 200
Mailing Address - City:PORT ORANGE
Mailing Address - State:FL
Mailing Address - Zip Code:32127-2911
Mailing Address - Country:US
Mailing Address - Phone:386-304-8112
Mailing Address - Fax:386-304-8014
Practice Address - Street 1:5100 S CLYDE MORRIS BLVD
Practice Address - Street 2:SUITE 200
Practice Address - City:PORT ORANGE
Practice Address - State:FL
Practice Address - Zip Code:32127-2911
Practice Address - Country:US
Practice Address - Phone:386-304-8112
Practice Address - Fax:386-304-8014
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-10-18
Last Update Date:2007-10-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLPT22239261QP2000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QP2000XAmbulatory Health Care FacilitiesClinic/CenterPhysical Therapy
Provider Identifiers
StateIdentifier IDID TypeIssuer
FLY093ZZMedicare PIN