Provider Demographics
NPI:1902861677
Name:HOFNER, RICHARD G (PT)
Entity Type:Individual
Prefix:
First Name:RICHARD
Middle Name:G
Last Name:HOFNER
Suffix:
Gender:M
Credentials:PT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:656 ELMWOOD AVE
Mailing Address - Street 2:SUITE202
Mailing Address - City:BUFFALO
Mailing Address - State:NY
Mailing Address - Zip Code:14222-1836
Mailing Address - Country:US
Mailing Address - Phone:716-883-0515
Mailing Address - Fax:716-883-8764
Practice Address - Street 1:656 ELMWOOD AVE
Practice Address - Street 2:SUITE202
Practice Address - City:BUFFALO
Practice Address - State:NY
Practice Address - Zip Code:14222-1836
Practice Address - Country:US
Practice Address - Phone:716-883-0515
Practice Address - Fax:716-883-8764
Is Sole Proprietor?:Not Answered
Enumeration Date:2006-04-18
Last Update Date:2007-07-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY01623463Medicaid
NY01623463Medicaid