MEDICARE: LORI ANN HOFF PTA

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	225200000X	Physical Therapy Assistant	477-019	WI

General Provider Information

NPI Number	:	1386811313
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	LORI ANN HOFF PTA

Provider Business Mailing Address
First Line	:	2244 WARM SPRINGS CT
Second Line	:
City	:	GREEN BAY
State	:	WI
Zip	:	54311-5032
Country	:	US
Telephone Number	:	920-469-4530
Fax Number	:

Provider Business Practice Location Address
First Line	:	2244 WARM SPRINGS CT
Second Line	:
City	:	GREEN BAY
State	:	WI
Zip	:	54311-5032
Country	:	US
Telephone Number	:	920-469-4530
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	05/08/2008
Last Update Date	:	05/08/2008

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Directions to “ LORI ANN HOFF PTA” Practice Location

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