Healthcare Provider Details

I. General information

NPI: 1417438755
Provider Name (Legal Business Name): DR. MEGAN HOFFMAN
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 08/24/2018
Last Update Date: 04/06/2021
Certification Date: 04/06/2021
Deactivation Date:
Reactivation Date:

III. Provider practice location address

16301 19 MILE RD
CLINTON TOWNSHIP MI
48038-1104
US

IV. Provider business mailing address

55311 NILE WAY
MACOMB MI
48042-6193
US

V. Phone/Fax

Practice location:
  • Phone: 586-263-2480
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code225100000X
TaxonomyPhysical Therapist
License Number5501018762
License Number StateMI

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: