Healthcare Provider Details

I. General information

NPI: 1376060186
Provider Name (Legal Business Name): JACOB NATHANIEL HOFFMAN DPT
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 08/23/2017
Last Update Date: 08/23/2017
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

13106 SE 240TH ST STE 103
KENT WA
98031-9211
US

IV. Provider business mailing address

2723 SUNSET CT
STEILACOOM WA
98388-2817
US

V. Phone/Fax

Practice location:
  • Phone: 425-413-4427
  • Fax:
Mailing address:
  • Phone: 253-320-8961
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code225100000X
TaxonomyPhysical Therapist
License Number
License Number State

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: