Provider Demographics
NPI:1043604820
Name:HOFFMAN, MICHAELA (LAT, ATC, CSCS)
Entity type:Individual
Prefix:
First Name:MICHAELA
Middle Name:
Last Name:HOFFMAN
Suffix:
Gender:F
Credentials:LAT, ATC, CSCS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:10035 NORTHBROOK VALLEY DR APT 8
Mailing Address - Street 2:
Mailing Address - City:FORT WAYNE
Mailing Address - State:IN
Mailing Address - Zip Code:46825-2380
Mailing Address - Country:US
Mailing Address - Phone:260-610-3454
Mailing Address - Fax:
Practice Address - Street 1:3701 CARROLL RD
Practice Address - Street 2:
Practice Address - City:FORT WAYNE
Practice Address - State:IN
Practice Address - Zip Code:46818-9528
Practice Address - Country:US
Practice Address - Phone:260-637-3161
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2015-03-19
Last Update Date:2019-09-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2255A2300XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersSpecialist/TechnologistAthletic Trainer
No390200000XStudent, Health CareStudent in an Organized Health Care Education/Training Program