Healthcare Provider Details

I. General information

NPI: 1295541605
Provider Name (Legal Business Name): CARLA RAE HOFFERBER PTA
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 12/10/2024
Last Update Date: 01/17/2025
Certification Date: 01/17/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1313 BROADWAY STE 200
TACOMA WA
98402-3400
US

IV. Provider business mailing address

908 N J ST
TACOMA WA
98403-2124
US

V. Phone/Fax

Practice location:
  • Phone: 253-301-6400
  • Fax:
Mailing address:
  • Phone: 425-466-7057
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code225200000X
TaxonomyPhysical Therapy Assistant
License Number60041439
License Number StateWA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: