Healthcare Provider Details

I. General information

NPI: 1619481249
Provider Name (Legal Business Name): ANDREW STEPHEN HOFFMANN LMT
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 11/17/2017
Last Update Date: 11/17/2017
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2705 E BURNSIDE ST STE 104
PORTLAND OR
97214-1767
US

IV. Provider business mailing address

2705 E BURNSIDE ST STE 104
PORTLAND OR
97214-1767
US

V. Phone/Fax

Practice location:
  • Phone: 630-788-0542
  • Fax:
Mailing address:
  • Phone: 630-788-0542
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code225700000X
TaxonomyMassage Therapist
License Number22383
License Number StateOR

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: