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General NPI Number Information
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NPI Number | 1619634318
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Entity Type | Individual
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Provider Name | JENNIFER HOFER LMT
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Gender | Female
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Dates
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Enumeration Date | 11/17/2021
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Last Update Date | 11/22/2021
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Provider Practice Location Address
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Address Line | 1321 POPLAR ST
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City | BENTON
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State | KY
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Zip | 42025-1567
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Country | US
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Telephone | 270-366-5598
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Fax |
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Provider Business Mailing Address
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Address Line | 853 VICKSBURG ESTATE RD
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City | BENTON
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State | KY
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Zip | 42025-8074
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Country | US
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Telephone | 270-366-5598
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Fax |
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 172M00000X
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Taxonomy Name | Mechanotherapist
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License Number | 267119
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License Number State | KY
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Taxonomy #2
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Taxonomy Code | 225700000X
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Taxonomy Name | Massage Therapist
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License Number | 267119
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License Number State | KY
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