Healthcare Provider Details

I. General information

NPI: 1427213941
Provider Name (Legal Business Name): LISA MARIE HOFFMAN PTA
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 07/24/2008
Last Update Date: 03/14/2017
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2501 ALLENTOWN RD
PEKIN IL
61554
US

IV. Provider business mailing address

2501 ALLENTOWN RD
PEKIN IL
61554-9401
US

V. Phone/Fax

Practice location:
  • Phone: 309-347-3121
  • Fax: 309-347-3607
Mailing address:
  • Phone: 309-347-3121
  • Fax: 309-347-3607

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code174400000X
TaxonomySpecialist
License Number160.004205
License Number StateIL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: