Healthcare Provider Details

I. General information

NPI: 1245429992
Provider Name (Legal Business Name): HOFFMAN PHYSICAL THERAPY, LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 10/18/2007
Last Update Date: 10/18/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

5100 S CLYDE MORRIS BLVD SUITE 200
PORT ORANGE FL
32127-2911
US

IV. Provider business mailing address

5100 S CLYDE MORRIS BLVD SUITE 200
PORT ORANGE FL
32127-2911
US

V. Phone/Fax

Practice location:
  • Phone: 386-304-8112
  • Fax: 386-304-8014
Mailing address:
  • Phone: 386-304-8112
  • Fax: 386-304-8014

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code261QP2000X
TaxonomyPhysical Therapy Clinic/Center
License NumberPT22239
License Number StateFL

VIII. Authorized Official

Name: ADAM M HOFFMAN
Title or Position: OWNER/PHYSICAL THERAPIST
Credential: PT
Phone: 386-304-8112