Healthcare Provider Details

I. General information

NPI: 1760904213
Provider Name (Legal Business Name): KEVIN MICHAEL HOFFMAN MS, LAT, ATC, OPE-C,
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 07/15/2017
Last Update Date: 09/26/2023
Certification Date: 09/26/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1683 BOSTON TPKE
COVENTRY CT
06238-1105
US

IV. Provider business mailing address

10 DRUMMOND DR APT G
ROCKY HILL CT
06067-3323
US

V. Phone/Fax

Practice location:
  • Phone: 860-498-7093
  • Fax:
Mailing address:
  • Phone: 860-638-7182
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code2255A2300X
TaxonomyAthletic Trainer
License NumberRT006757
License Number StatePA
# 2
Primary TaxonomyY
Taxonomy Code2255A2300X
TaxonomyAthletic Trainer
License Number001239
License Number StateCT

VII. Legacy identifiers

For crosswalk purposes, the following legacy (non-NPI) identifiers are available for this provider:

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: