Healthcare Provider Details

I. General information

NPI: 1912643875
Provider Name (Legal Business Name): COLIN HOFFMASTER
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 05/12/2022
Last Update Date: 05/12/2022
Certification Date: 05/12/2022
Deactivation Date:
Reactivation Date:

III. Provider practice location address

406 GAYLEY ST APT B308
MEDIA PA
19063-3778
US

IV. Provider business mailing address

406 GAYLEY ST APT B308
MEDIA PA
19063-3778
US

V. Phone/Fax

Practice location:
  • Phone: 410-387-8073
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code225700000X
TaxonomyMassage Therapist
License NumberMSG013817
License Number StatePA
# 2
Primary TaxonomyY
Taxonomy Code2255A2300X
TaxonomyAthletic Trainer
License Number
License Number State

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: