Provider Demographics
NPI:1962630459
Name:HOOTMAN, CAROLINE (MT)
Entity Type:Individual
Prefix:MRS
First Name:CAROLINE
Middle Name:
Last Name:HOOTMAN
Suffix:
Gender:F
Credentials:MT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:278 TOWN CENTER PKWY
Mailing Address - Street 2:SUITE 101
Mailing Address - City:SANTEE
Mailing Address - State:CA
Mailing Address - Zip Code:92071-5800
Mailing Address - Country:US
Mailing Address - Phone:619-258-5810
Mailing Address - Fax:619-258-5693
Practice Address - Street 1:278 TOWN CENTER PKWY
Practice Address - Street 2:SUITE 101
Practice Address - City:SANTEE
Practice Address - State:CA
Practice Address - Zip Code:92071-5800
Practice Address - Country:US
Practice Address - Phone:619-258-5810
Practice Address - Fax:619-258-5693
Is Sole Proprietor?:Yes
Enumeration Date:2009-06-23
Last Update Date:2009-06-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA15239225700000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225700000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersMassage Therapist