MEDICARE: MS. SUZANNE RENAE HOEFER PTA

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	225200000X	Physical Therapy Assistant	1269	NE

General Provider Information

NPI Number	:	1447656434
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MS. SUZANNE RENAE HOEFER PTA

Provider Business Mailing Address
First Line	:	51917 834 RD
Second Line	:
City	:	PETERSBURG
State	:	NE
Zip	:	68652-8000
Country	:	US
Telephone Number	:	402-843-6438
Fax Number	:

Provider Business Practice Location Address
First Line	:	1923 W 4TH AVE
Second Line	:
City	:	HOLDREGE
State	:	NE
Zip	:	68949-3113
Country	:	US
Telephone Number	:	308-995-4493
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	11/18/2014
Last Update Date	:	11/18/2014

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