Provider Demographics
NPI:1245375104
Name:HOFFMAN, ROSS C (LMT)
Entity type:Individual
Prefix:MR
First Name:ROSS
Middle Name:C
Last Name:HOFFMAN
Suffix:
Gender:M
Credentials:LMT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3125 SE CARD TER
Mailing Address - Street 2:
Mailing Address - City:PORT SAINT LUCIE
Mailing Address - State:FL
Mailing Address - Zip Code:34984-6327
Mailing Address - Country:US
Mailing Address - Phone:772-359-3608
Mailing Address - Fax:
Practice Address - Street 1:139 SW PORT ST LUCIE BLVD
Practice Address - Street 2:SUITE B
Practice Address - City:PORT SAINT LUCIE
Practice Address - State:FL
Practice Address - Zip Code:34984-5031
Practice Address - Country:US
Practice Address - Phone:772-340-0022
Practice Address - Fax:888-481-6640
Is Sole Proprietor?:Yes
Enumeration Date:2007-02-20
Last Update Date:2013-01-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLMA0027888225700000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225700000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersMassage Therapist
Provider Identifiers
StateIdentifier IDID TypeIssuer
FLC8847OtherBLUE CROSS BLUE SHIELD
FLMA27888OtherMASSAGE LICENCE #