Healthcare Provider Details

I. General information

NPI: 1467649541
Provider Name (Legal Business Name): JERICA JOAN HOFFMAN P.T
Entity Type: Individual
Gender: Female
Sole Proprietor: N

Provider Other Name: JERICA SVETINA

II. Dates (important events)

Enumeration Date: 10/02/2007
Last Update Date: 12/19/2018
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

771 N FREEDOM ST
RAVENNA OH
44266-2470
US

IV. Provider business mailing address

771 N FREEDOM ST
RAVENNA OH
44266-2470
US

V. Phone/Fax

Practice location:
  • Phone: 330-297-9020
  • Fax: 330-297-9095
Mailing address:
  • Phone: 330-297-9020
  • Fax: 330-297-9095

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code225100000X
TaxonomyPhysical Therapist
License NumberPT-11403
License Number StateOH

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: