Healthcare Provider Details

I. General information

NPI: 1447813530
Provider Name (Legal Business Name): NEIL FRANKLIN HOFBAUER PT, DPT
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 04/15/2019
Last Update Date: 04/15/2019
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

201 9TH ST
MARINA CA
93933-6039
US

IV. Provider business mailing address

201 9TH ST
MARINA CA
93933-6039
US

V. Phone/Fax

Practice location:
  • Phone: 831-884-1097
  • Fax:
Mailing address:
  • Phone: 831-884-1097
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code225100000X
TaxonomyPhysical Therapist
License Number295231
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: