Healthcare Provider Details

I. General information

NPI: 1316187636
Provider Name (Legal Business Name): JEANNETTE NICOLE HOFFMAN LMT
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 02/26/2009
Last Update Date: 02/26/2009
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3804 FISHINGER BLVD
HILLIARD OH
43026-9551
US

IV. Provider business mailing address

135 NORTH ST
GAHANNA OH
43230-3015
US

V. Phone/Fax

Practice location:
  • Phone: 614-777-0222
  • Fax:
Mailing address:
  • Phone: 614-448-7134
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code172M00000X
TaxonomyMechanotherapist
License Number33.014894
License Number StateOH

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: