Healthcare Provider Details

I. General information

NPI: 1821723131
Provider Name (Legal Business Name): STEPHEN HOOGHUIS
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 07/20/2022
Last Update Date: 07/20/2022
Certification Date: 07/20/2022
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2400 MCKINNEY BLVD
COLONIAL BEACH VA
22443-1237
US

IV. Provider business mailing address

2502 NE 12TH ST
GAINESVILLE FL
32609-3158
US

V. Phone/Fax

Practice location:
  • Phone: 804-224-2222
  • Fax:
Mailing address:
  • Phone: 352-226-9603
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code225200000X
TaxonomyPhysical Therapy Assistant
License NumberPTA30217
License Number StateFL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: