Provider Demographics
NPI:1760904213
Name:HOFFMAN, KEVIN MICHAEL (MS, LAT, ATC, OPE-C,)
Entity Type:Individual
Prefix:
First Name:KEVIN
Middle Name:MICHAEL
Last Name:HOFFMAN
Suffix:
Gender:M
Credentials:MS, LAT, ATC, OPE-C,
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:10 DRUMMOND DR APT G
Mailing Address - Street 2:
Mailing Address - City:ROCKY HILL
Mailing Address - State:CT
Mailing Address - Zip Code:06067-3323
Mailing Address - Country:US
Mailing Address - Phone:860-638-7182
Mailing Address - Fax:
Practice Address - Street 1:1683 BOSTON TPKE
Practice Address - Street 2:
Practice Address - City:COVENTRY
Practice Address - State:CT
Practice Address - Zip Code:06238-1105
Practice Address - Country:US
Practice Address - Phone:860-498-7093
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2017-07-15
Last Update Date:2023-09-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PART0067572255A2300X
CT0012392255A2300X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2255A2300XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersSpecialist/TechnologistAthletic Trainer