Provider Demographics
NPI:1598763351
Name:HOFFMAN, BETHANY LYNN (PT)
Entity Type:Individual
Prefix:MRS
First Name:BETHANY
Middle Name:LYNN
Last Name:HOFFMAN
Suffix:
Gender:F
Credentials:PT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:183 PEACE BLVD
Mailing Address - Street 2:
Mailing Address - City:SAINT JOSEPH
Mailing Address - State:MI
Mailing Address - Zip Code:49085-9146
Mailing Address - Country:US
Mailing Address - Phone:269-408-1636
Mailing Address - Fax:
Practice Address - Street 1:183 PEACE BLVD
Practice Address - Street 2:
Practice Address - City:SAINT JOSEPH
Practice Address - State:MI
Practice Address - Zip Code:49085-9146
Practice Address - Country:US
Practice Address - Phone:269-408-1636
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2005-07-14
Last Update Date:2010-09-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI55010092372251X0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2251X0800XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical TherapistOrthopedic