Provider Demographics
NPI:1467649541
Name:HOFFMAN, JERICA JOAN (PT)
Entity type:Individual
Prefix:
First Name:JERICA
Middle Name:JOAN
Last Name:HOFFMAN
Suffix:
Gender:F
Credentials:PT
Other - Prefix:
Other - First Name:JERICA
Other - Middle Name:
Other - Last Name:SVETINA
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:771 N FREEDOM ST
Mailing Address - Street 2:
Mailing Address - City:RAVENNA
Mailing Address - State:OH
Mailing Address - Zip Code:44266-2470
Mailing Address - Country:US
Mailing Address - Phone:330-297-9020
Mailing Address - Fax:330-297-9095
Practice Address - Street 1:771 N FREEDOM ST
Practice Address - Street 2:
Practice Address - City:RAVENNA
Practice Address - State:OH
Practice Address - Zip Code:44266-2470
Practice Address - Country:US
Practice Address - Phone:330-297-9020
Practice Address - Fax:330-297-9095
Is Sole Proprietor?:No
Enumeration Date:2007-10-02
Last Update Date:2018-12-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OHPT-11403225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist
Provider Identifiers
StateIdentifier IDID TypeIssuer
OHSV4221141Medicare PIN