Healthcare Provider Details

I. General information

NPI: 1568770840
Provider Name (Legal Business Name): ADRIENNE CECILY HOFMANN MPT
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 09/20/2010
Last Update Date: 08/17/2020
Certification Date: 08/17/2020
Deactivation Date:
Reactivation Date:

III. Provider practice location address

101 HODENCAMP RD 100
THOUSAND OAKS CA
91360-5836
US

IV. Provider business mailing address

101 HODENCAMP RD 100
THOUSAND OAKS CA
91360-5836
US

V. Phone/Fax

Practice location:
  • Phone: 805-495-0516
  • Fax: 805-381-9366
Mailing address:
  • Phone: 805-495-0516
  • Fax: 805-381-9366

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code2251X0800X
TaxonomyOrthopedic Physical Therapist
License Number37019
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: