Provider Demographics
NPI:1316401763
Name:HOFFMANN, ELIZABETH (LMT 24548)
Entity Type:Individual
Prefix:
First Name:ELIZABETH
Middle Name:
Last Name:HOFFMANN
Suffix:
Gender:F
Credentials:LMT 24548
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:120 SW 4TH ST STE 150
Mailing Address - Street 2:
Mailing Address - City:CORVALLIS
Mailing Address - State:OR
Mailing Address - Zip Code:97333-4896
Mailing Address - Country:US
Mailing Address - Phone:678-378-0777
Mailing Address - Fax:
Practice Address - Street 1:120 SW 4TH ST STE 150
Practice Address - Street 2:
Practice Address - City:CORVALLIS
Practice Address - State:OR
Practice Address - Zip Code:97333-4896
Practice Address - Country:US
Practice Address - Phone:678-378-0777
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2019-01-29
Last Update Date:2019-01-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OR24548225700000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225700000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersMassage Therapist