Provider Demographics
NPI:1447656434
Name:HOEFER, SUZANNE RENAE (PTA)
Entity type:Individual
Prefix:MS
First Name:SUZANNE
Middle Name:RENAE
Last Name:HOEFER
Suffix:
Gender:F
Credentials:PTA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:51917 834 RD
Mailing Address - Street 2:
Mailing Address - City:PETERSBURG
Mailing Address - State:NE
Mailing Address - Zip Code:68652-8000
Mailing Address - Country:US
Mailing Address - Phone:402-843-6438
Mailing Address - Fax:
Practice Address - Street 1:1923 W 4TH AVE
Practice Address - Street 2:
Practice Address - City:HOLDREGE
Practice Address - State:NE
Practice Address - Zip Code:68949-3113
Practice Address - Country:US
Practice Address - Phone:308-995-4493
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2014-11-18
Last Update Date:2014-11-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NE1269225200000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225200000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapy Assistant