Provider Demographics
NPI:1376062059
Name:STILES-HOFLAND, SUSETTE ADA (PT)
Entity Type:Individual
Prefix:
First Name:SUSETTE
Middle Name:ADA
Last Name:STILES-HOFLAND
Suffix:
Gender:F
Credentials:PT
Other - Prefix:
Other - First Name:SUSIE
Other - Middle Name:
Other - Last Name:HOFLAND
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:PT
Mailing Address - Street 1:PO BOX 572
Mailing Address - Street 2:
Mailing Address - City:SUNDANCE
Mailing Address - State:WY
Mailing Address - Zip Code:82729-0572
Mailing Address - Country:US
Mailing Address - Phone:307-290-0572
Mailing Address - Fax:
Practice Address - Street 1:620 S 4J CT
Practice Address - Street 2:
Practice Address - City:GILLETTE
Practice Address - State:WY
Practice Address - Zip Code:82716-4130
Practice Address - Country:US
Practice Address - Phone:307-290-0572
Practice Address - Fax:307-290-0572
Is Sole Proprietor?:No
Enumeration Date:2017-09-14
Last Update Date:2017-09-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WYPT-0523225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist