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NPI Code Detail

MEDICARE: SHANNON ENID HOFFMAN LPTA

MEDICARE: SHANNON ENID HOFFMAN LPTA
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
1225200000XPhysical Therapy AssistantPTA-2307OH

General Provider Information

NPI Number : 1851411839
Entity Type Code : Individual
Provider Name (Legal Business Name) : SHANNON ENID HOFFMAN LPTA
Provider Business Mailing Address
First Line : 1323 BROCKLEY AVE
Second Line :
City : LAKEWOOD
State : OH
Zip : 44107-2440
Country : US
Telephone Number : 216-254-7969
Fax Number :
Provider Business Practice Location Address
First Line : 6606 CARNEGIE AVE
Second Line :
City : CLEVELAND
State : OH
Zip : 44103-4622
Country : US
Telephone Number : 216-361-1414
Fax Number :
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 03/31/2007
Last Update Date : 07/08/2007

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Directions to “ SHANNON ENID HOFFMAN LPTA” Practice Location

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