Provider Demographics
NPI:1669641486
Name:HOFFMAN, KELLY M (MSPT)
Entity Type:Individual
Prefix:
First Name:KELLY
Middle Name:M
Last Name:HOFFMAN
Suffix:
Gender:F
Credentials:MSPT
Other - Prefix:
Other - First Name:KELLY
Other - Middle Name:M
Other - Last Name:READ
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:MSPT
Mailing Address - Street 1:95 MATHEWS DR STE D5
Mailing Address - Street 2:
Mailing Address - City:HILTON HEAD
Mailing Address - State:SC
Mailing Address - Zip Code:29926-3768
Mailing Address - Country:US
Mailing Address - Phone:843-681-5640
Mailing Address - Fax:843-681-5631
Practice Address - Street 1:95 MATHEWS DR STE D5
Practice Address - Street 2:
Practice Address - City:HILTON HEAD
Practice Address - State:SC
Practice Address - Zip Code:29926-3768
Practice Address - Country:US
Practice Address - Phone:843-681-5640
Practice Address - Fax:843-681-5631
Is Sole Proprietor?:No
Enumeration Date:2008-02-26
Last Update Date:2008-07-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
SC5666225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist
Provider Identifiers
StateIdentifier IDID TypeIssuer
SCQ348038783Medicare Oscar/Certification