Healthcare Provider Details

I. General information

NPI: 1134673452
Provider Name (Legal Business Name): MINDY HOFFMAN DPT
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 08/04/2016
Last Update Date: 08/04/2016
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

112 E 5TH AVE
ANTIGO WI
54409-2710
US

IV. Provider business mailing address

112 E 5TH AVE
ANTIGO WI
54409-2710
US

V. Phone/Fax

Practice location:
  • Phone: 715-623-9449
  • Fax: 715-623-9425
Mailing address:
  • Phone: 715-623-9449
  • Fax: 715-623-9425

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code225100000X
TaxonomyPhysical Therapist
License Number13580-24
License Number StateWI

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: