Healthcare Provider Details

I. General information

NPI: 1801802301
Provider Name (Legal Business Name): MARK ALAN HOFFMEYER PT
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 08/01/2006
Last Update Date: 10/27/2009
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3491 LINCOLN RD.
HAMILTON MI
49419
US

IV. Provider business mailing address

44 E. 8TH STREET SUITE 205
HOLLAND MI
49423
US

V. Phone/Fax

Practice location:
  • Phone: 269-751-2150
  • Fax:
Mailing address:
  • Phone: 616-392-3197
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code225100000X
TaxonomyPhysical Therapist
License Number5501002211
License Number StateMI

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: