Provider Demographics
NPI:1871758797
Name:HOFFMAN, JORDANA D (MS PT)
Entity type:Individual
Prefix:
First Name:JORDANA
Middle Name:D
Last Name:HOFFMAN
Suffix:
Gender:F
Credentials:MS PT
Other - Prefix:
Other - First Name:JORDANA
Other - Middle Name:
Other - Last Name:DISTASIO
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:MPT
Mailing Address - Street 1:771 PILOT HOUSE DR
Mailing Address - Street 2:
Mailing Address - City:NEWPORT NEWS
Mailing Address - State:VA
Mailing Address - Zip Code:23606-1990
Mailing Address - Country:US
Mailing Address - Phone:757-873-2302
Mailing Address - Fax:757-873-2306
Practice Address - Street 1:2106 EXECUTIVE DR
Practice Address - Street 2:
Practice Address - City:HAMPTON
Practice Address - State:VA
Practice Address - Zip Code:23666-2402
Practice Address - Country:US
Practice Address - Phone:757-838-6678
Practice Address - Fax:757-838-8116
Is Sole Proprietor?:No
Enumeration Date:2008-07-21
Last Update Date:2010-05-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA2305205540225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist
Provider Identifiers
StateIdentifier IDID TypeIssuer
VA9567180OtherAETNA
VA192971OtherBCBS PHYSICAL THERAPY
VA1871758797Medicaid
VAP00634361OtherRAILROAD MEDICARE
VAC05954Medicare PIN
VA9567180OtherAETNA