=====================================================
General NPI Number Information
=====================================================
NPI Number | 1972317477
-----------------------------------------------------
Entity Type | Individual
-----------------------------------------------------
Provider Name | JESSICA HOFHERR DPT
-----------------------------------------------------
Gender | Female
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 02/04/2025
-----------------------------------------------------
Last Update Date | 02/04/2025
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 272 KROGER CTR
-----------------------------------------------------
City | MOREHEAD
-----------------------------------------------------
State | KY
-----------------------------------------------------
Zip | 40351-8894
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 185-987-8289
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 9095 HIGHWAY 772
-----------------------------------------------------
City | WEST LIBERTY
-----------------------------------------------------
State | KY
-----------------------------------------------------
Zip | 41472-7216
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 925-207-9242
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position |
-----------------------------------------------------
Name |
-----------------------------------------------------
Credential |
-----------------------------------------------------
Telephone |
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 225100000X
-----------------------------------------------------
Taxonomy Name | Physical Therapist
-----------------------------------------------------
License Number | 009262
-----------------------------------------------------
License Number State | KY
-----------------------------------------------------