Provider Demographics
NPI:1568645919
Name:HOFFMANN, GINA (LMT)
Entity Type:Individual
Prefix:MS
First Name:GINA
Middle Name:
Last Name:HOFFMANN
Suffix:
Gender:F
Credentials:LMT
Other - Prefix:
Other - First Name:GINA
Other - Middle Name:
Other - Last Name:HOFFMANN
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:LMT
Mailing Address - Street 1:1234 NE 74TH AVE
Mailing Address - Street 2:
Mailing Address - City:PORTLAND
Mailing Address - State:OR
Mailing Address - Zip Code:97213-6119
Mailing Address - Country:US
Mailing Address - Phone:503-403-9176
Mailing Address - Fax:
Practice Address - Street 1:3939 NE HANCOCK ST STE 311
Practice Address - Street 2:
Practice Address - City:PORTLAND
Practice Address - State:OR
Practice Address - Zip Code:97212-5321
Practice Address - Country:US
Practice Address - Phone:503-403-9176
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2007-12-07
Last Update Date:2022-08-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OR14208225700000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225700000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersMassage Therapist