Healthcare Provider Details

I. General information

NPI: 1356426514
Provider Name (Legal Business Name): JUSTIN HOFHINES M.P.T., A.T.C.
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 10/26/2006
Last Update Date: 07/08/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

9882 W STATE ST
STAR ID
83669-5210
US

IV. Provider business mailing address

2680 WILDWOOD ST
BOISE ID
83713-5065
US

V. Phone/Fax

Practice location:
  • Phone: 208-286-0766
  • Fax: 208-286-0768
Mailing address:
  • Phone: 208-377-1673
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code225100000X
TaxonomyPhysical Therapist
License NumberPT-1923
License Number StateID

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: