Healthcare Provider Details

I. General information

NPI: 1962032391
Provider Name (Legal Business Name): HOFFA MASSAGE THERAPY
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 01/24/2020
Last Update Date: 01/24/2020
Certification Date: 01/24/2020
Deactivation Date:
Reactivation Date:

III. Provider practice location address

242 KING AVE
ATHENS GA
30606
US

IV. Provider business mailing address

425 OAK GROVE RD
ATHENS GA
30607-1707
US

V. Phone/Fax

Practice location:
  • Phone: 706-254-3333
  • Fax: 706-510-0659
Mailing address:
  • Phone: 706-254-3333
  • Fax: 706-510-0659

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code225700000X
TaxonomyMassage Therapist
License Number
License Number State

VIII. Authorized Official

Name: MICHAEL REESE HOFFA
Title or Position: OWNER
Credential: LMT,MMP
Phone: 706-254-3333