Provider Demographics
NPI:1831598762
Name:IQBAL-HOFMEISTER, SAMUEL LEWIS (DPT)
Entity type:Individual
Prefix:
First Name:SAMUEL
Middle Name:LEWIS
Last Name:IQBAL-HOFMEISTER
Suffix:
Gender:M
Credentials:DPT
Other - Prefix:
Other - First Name:SAMUEL
Other - Middle Name:LEWIS
Other - Last Name:HOFMEISTER
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:10255 LIVE OAK BLVD
Mailing Address - Street 2:
Mailing Address - City:LIVE OAK
Mailing Address - State:CA
Mailing Address - Zip Code:95953-2015
Mailing Address - Country:US
Mailing Address - Phone:530-695-3700
Mailing Address - Fax:530-695-3780
Practice Address - Street 1:10255 LIVE OAK BLVD
Practice Address - Street 2:
Practice Address - City:LIVE OAK
Practice Address - State:CA
Practice Address - Zip Code:95953-2015
Practice Address - Country:US
Practice Address - Phone:530-695-3700
Practice Address - Fax:530-695-3780
Is Sole Proprietor?:No
Enumeration Date:2014-08-15
Last Update Date:2022-02-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NV3024225100000X
ID3589225100000X
CA42759225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist