Provider Demographics
NPI:1407282429
Name:HOFFMAN, MEAGAN (PT)
Entity Type:Individual
Prefix:
First Name:MEAGAN
Middle Name:
Last Name:HOFFMAN
Suffix:
Gender:F
Credentials:PT
Other - Prefix:
Other - First Name:MEAGAN
Other - Middle Name:
Other - Last Name:KAMENS
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:PT
Mailing Address - Street 1:47 N MAIN ST
Mailing Address - Street 2:
Mailing Address - City:WEST HARTFORD
Mailing Address - State:CT
Mailing Address - Zip Code:06107-1926
Mailing Address - Country:US
Mailing Address - Phone:860-409-4595
Mailing Address - Fax:860-409-4860
Practice Address - Street 1:5 PEQUOT PARK RD
Practice Address - Street 2:SUITE 102
Practice Address - City:WESTBROOK
Practice Address - State:CT
Practice Address - Zip Code:06498-2856
Practice Address - Country:US
Practice Address - Phone:860-399-6411
Practice Address - Fax:860-399-6822
Is Sole Proprietor?:No
Enumeration Date:2013-09-23
Last Update Date:2016-08-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CT009907225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist
Provider Identifiers
StateIdentifier IDID TypeIssuer
CT009907OtherCONNECTICUT LICENSE