Healthcare Provider Details

I. General information

NPI: 1447886254
Provider Name (Legal Business Name): TERESA ELAINE HOFFER LMT
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 03/13/2020
Last Update Date: 03/13/2020
Certification Date: 03/13/2020
Deactivation Date:
Reactivation Date:

III. Provider practice location address

176 S 30TH ST
NEWARK OH
43055-1941
US

IV. Provider business mailing address

7610 HUPP RD
THORNVILLE OH
43076-8808
US

V. Phone/Fax

Practice location:
  • Phone: 740-344-4447
  • Fax: 740-344-3346
Mailing address:
  • Phone: 614-309-3960
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code225700000X
TaxonomyMassage Therapist
License Number33.019291
License Number StateOH

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: