Healthcare Provider Details

I. General information

NPI: 1922784784
Provider Name (Legal Business Name): ROSS HOFELE MAT, ATC
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 06/26/2023
Last Update Date: 06/26/2023
Certification Date: 06/26/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2125 STATE ST STE 5
NEW ALBANY IN
47150-4901
US

IV. Provider business mailing address

11531 LIBERTY BELL LN
SELLERSBURG IN
47172-8400
US

V. Phone/Fax

Practice location:
  • Phone: 812-944-2663
  • Fax:
Mailing address:
  • Phone: 859-803-0478
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code2255A2300X
TaxonomyAthletic Trainer
License Number36002798A
License Number StateIN

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: