Healthcare Provider Details

I. General information

NPI: 1912530015
Provider Name (Legal Business Name): TYLER ROBERT HOFFMAN
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 02/17/2020
Last Update Date: 02/17/2020
Certification Date: 02/17/2020
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2001 NEWBURG RD
LOUISVILLE KY
40205-1877
US

IV. Provider business mailing address

22480 BLOSSOM CT
GOSHEN IN
46528-8325
US

V. Phone/Fax

Practice location:
  • Phone: 574-312-4565
  • Fax:
Mailing address:
  • Phone: 574-312-4565
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code2255A2300X
TaxonomyAthletic Trainer
License Number
License Number State

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: