MEDICARE: KEVIN MICHAEL HOFFMAN MS, LAT, ATC, OPE-C,

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	RT006757	PA
2	2255A2300X	Athletic Trainer	001239	CT

General Provider Information

NPI Number	:	1760904213
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	KEVIN MICHAEL HOFFMAN MS, LAT, ATC, OPE-C,

Provider Business Mailing Address
First Line	:	10 DRUMMOND DR APT G
Second Line	:
City	:	ROCKY HILL
State	:	CT
Zip	:	06067-3323
Country	:	US
Telephone Number	:	860-638-7182
Fax Number	:

Provider Business Practice Location Address
First Line	:	1683 BOSTON TPKE
Second Line	:
City	:	COVENTRY
State	:	CT
Zip	:	06238-1105
Country	:	US
Telephone Number	:	860-498-7093
Fax Number	:

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

Provider Enumeration Date	:	07/15/2017
Last Update Date	:	09/26/2023

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