Healthcare Provider Details

I. General information

NPI: 1700603560
Provider Name (Legal Business Name): KAYLA KRISTINE HOFFMAN DPT
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 09/23/2024
Last Update Date: 09/23/2024
Certification Date: 09/23/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

221 NE GLEN OAK AVE
PEORIA IL
61636-0001
US

IV. Provider business mailing address

2900 FRANK SCOTT PKWY W STE 930
BELLEVILLE IL
62223-5010
US

V. Phone/Fax

Practice location:
  • Phone: 309-672-5522
  • Fax:
Mailing address:
  • Phone: 618-234-9705
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code225100000X
TaxonomyPhysical Therapist
License Number070.028639
License Number StateIL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: