Provider Demographics
NPI:1598488207
Name:HOEFFNER, CRAIG R (LMT)
Entity Type:Individual
Prefix:
First Name:CRAIG
Middle Name:R
Last Name:HOEFFNER
Suffix:
Gender:M
Credentials:LMT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:851 COHO WAY STE 312
Mailing Address - Street 2:
Mailing Address - City:BELLINGHAM
Mailing Address - State:WA
Mailing Address - Zip Code:98225-2066
Mailing Address - Country:US
Mailing Address - Phone:360-224-4579
Mailing Address - Fax:
Practice Address - Street 1:851 COHO WAY STE 312
Practice Address - Street 2:
Practice Address - City:BELLINGHAM
Practice Address - State:WA
Practice Address - Zip Code:98225-2066
Practice Address - Country:US
Practice Address - Phone:360-224-4579
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2022-09-19
Last Update Date:2022-09-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WAMA61319235225700000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225700000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersMassage Therapist