Healthcare Provider Details

I. General information

NPI: 1386320869
Provider Name (Legal Business Name): SUSAN HOFER
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 06/27/2023
Last Update Date: 06/27/2023
Certification Date: 06/27/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

544 HUNSICKER RD
TELFORD PA
18969-2425
US

IV. Provider business mailing address

544 HUNSICKER RD
TELFORD PA
18969-2425
US

V. Phone/Fax

Practice location:
  • Phone: 484-674-5685
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code225700000X
TaxonomyMassage Therapist
License NumberMSG012074
License Number StatePA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: