Provider Demographics
NPI:1356426514
Name:HOFHINES, JUSTIN (MPT, ATC)
Entity type:Individual
Prefix:MR
First Name:JUSTIN
Middle Name:
Last Name:HOFHINES
Suffix:
Gender:M
Credentials:MPT, ATC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2680 WILDWOOD ST
Mailing Address - Street 2:
Mailing Address - City:BOISE
Mailing Address - State:ID
Mailing Address - Zip Code:83713-5065
Mailing Address - Country:US
Mailing Address - Phone:208-377-1673
Mailing Address - Fax:
Practice Address - Street 1:9882 W STATE ST
Practice Address - Street 2:
Practice Address - City:STAR
Practice Address - State:ID
Practice Address - Zip Code:83669-5210
Practice Address - Country:US
Practice Address - Phone:208-286-0766
Practice Address - Fax:208-286-0768
Is Sole Proprietor?:No
Enumeration Date:2006-10-26
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IDPT-1923225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist