MEDICARE: PETER KEITH HOFFER ATC, LAT

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	2255A2300X	Athletic Trainer	3456	MN

General Provider Information

NPI Number	:	1689521759
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	PETER KEITH HOFFER ATC, LAT

Provider Business Mailing Address
First Line	:	775 PRAIRIE CENTER DR
Second Line	:
City	:	EDEN PRAIRIE
State	:	MN
Zip	:	55344-7314
Country	:	US
Telephone Number	:	952-428-5700
Fax Number	:

Provider Business Practice Location Address
First Line	:	775 PRAIRIE CENTER DR
Second Line	:
City	:	EDEN PRAIRIE
State	:	MN
Zip	:	55344-7314
Country	:	US
Telephone Number	:	952-428-5700
Fax Number	:

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

Provider Enumeration Date	:	03/16/2026
Last Update Date	:	03/16/2026

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