Healthcare Provider Details

I. General information

NPI: 1619634318
Provider Name (Legal Business Name): JENNIFER HOFER LMT
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 11/17/2021
Last Update Date: 11/22/2021
Certification Date: 11/22/2021
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1321 POPLAR ST
BENTON KY
42025-1567
US

IV. Provider business mailing address

853 VICKSBURG ESTATE RD
BENTON KY
42025-8074
US

V. Phone/Fax

Practice location:
  • Phone: 270-366-5598
  • Fax:
Mailing address:
  • Phone: 270-366-5598
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code172M00000X
TaxonomyMechanotherapist
License Number267119
License Number StateKY
# 2
Primary TaxonomyY
Taxonomy Code225700000X
TaxonomyMassage Therapist
License Number267119
License Number StateKY

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: