Provider Demographics
NPI:1255583779
Name:HOHMANN, CHRYSTEL SCHORTAU (LMT)
Entity type:Individual
Prefix:MS
First Name:CHRYSTEL
Middle Name:SCHORTAU
Last Name:HOHMANN
Suffix:
Gender:F
Credentials:LMT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1164 6TH AVE N
Mailing Address - Street 2:
Mailing Address - City:PAYETTE
Mailing Address - State:ID
Mailing Address - Zip Code:83661-2480
Mailing Address - Country:US
Mailing Address - Phone:541-235-6061
Mailing Address - Fax:
Practice Address - Street 1:425 S WHITLEY DR
Practice Address - Street 2:FRUITLAND BUSINESS CENTER SUITE 3
Practice Address - City:FRUITLAND
Practice Address - State:ID
Practice Address - Zip Code:83619-2611
Practice Address - Country:US
Practice Address - Phone:541-235-6061
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2008-10-15
Last Update Date:2011-08-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OR7726225700000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225700000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersMassage Therapist
Provider Identifiers
StateIdentifier IDID TypeIssuer
IDCH1026883OtherAMERICAN HEALTH SPECIALTY HEALTH NETWORKS,INC.