Provider Demographics
NPI:1629237631
Name:HOFMANN, MELISSA CAROLE (MSPT)
Entity Type:Individual
Prefix:
First Name:MELISSA
Middle Name:CAROLE
Last Name:HOFMANN
Suffix:
Gender:F
Credentials:MSPT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2617 NE 13TH CT
Mailing Address - Street 2:APT.6
Mailing Address - City:FORT LAUDERDALE
Mailing Address - State:FL
Mailing Address - Zip Code:33304-1512
Mailing Address - Country:US
Mailing Address - Phone:310-650-8332
Mailing Address - Fax:
Practice Address - Street 1:2617 NE 13TH CT
Practice Address - Street 2:APT.6
Practice Address - City:FORT LAUDERDALE
Practice Address - State:FL
Practice Address - Zip Code:33304-1512
Practice Address - Country:US
Practice Address - Phone:310-650-8332
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2008-06-04
Last Update Date:2008-06-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FL22805225100000X
CA26827225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist