Healthcare Provider Details

I. General information

NPI: 1992160089
Provider Name (Legal Business Name): JOHN HOFFMANN LMT
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 12/16/2015
Last Update Date: 12/16/2015
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2526 NE 15TH AVE
PORTLAND OR
97212-4222
US

IV. Provider business mailing address

3439 NE SANDY BLVD # 342
PORTLAND OR
97232-1959
US

V. Phone/Fax

Practice location:
  • Phone: 503-288-7668
  • Fax: 503-288-8972
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code225700000X
TaxonomyMassage Therapist
License Number20424
License Number StateOR

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: