Healthcare Provider Details

I. General information

NPI: 1528842697
Provider Name (Legal Business Name): ZACHARIAH JOHN HOFSCHNEIDER LMT
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 08/21/2023
Last Update Date: 08/21/2023
Certification Date: 08/21/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

221A NE 104TH AVE STE 205
VANCOUVER WA
98664-4539
US

IV. Provider business mailing address

11900 NE 18TH ST APT AE45
VANCOUVER WA
98684-4717
US

V. Phone/Fax

Practice location:
  • Phone: 360-737-9665
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code225700000X
TaxonomyMassage Therapist
License NumberMA61478832
License Number StateWA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: