Provider Demographics
NPI:1023567484
Name:HOFFMAN, CHANEL R (PTA)
Entity type:Individual
Prefix:MRS
First Name:CHANEL
Middle Name:R
Last Name:HOFFMAN
Suffix:
Gender:F
Credentials:PTA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:605 E HOLLAND AVE
Mailing Address - Street 2:SUITE 112
Mailing Address - City:SPOKANE
Mailing Address - State:WA
Mailing Address - Zip Code:99218-2225
Mailing Address - Country:US
Mailing Address - Phone:509-755-5480
Mailing Address - Fax:
Practice Address - Street 1:605 E HOLLAND AVE
Practice Address - Street 2:SUITE 112
Practice Address - City:SPOKANE
Practice Address - State:WA
Practice Address - Zip Code:99218-2225
Practice Address - Country:US
Practice Address - Phone:509-755-5480
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2016-09-27
Last Update Date:2016-09-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WAP1 60173806225200000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225200000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapy Assistant