Organization
CONTRACT PHYSICAL THERAPY
Active
Organization subpart
No
Provider details
NPI number
Authorized official
JENNIFER HOFFMAN (PHYSICAL THERAPIST)
(814) 723-8828
Entity
Organization
Contact information
Practice address
109 RUSSELL ST, WARREN, PA 16365-2970
(814) 723-8828
Mailing address
109 RUSSELL ST, WARREN, PA 16365-2970
(814) 723-8828
Taxonomy
Speciality
Code
Description
License number
State
252Y00000X
Early Intervention Provider Agency
Primary
PT013046L
PA
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
1008522000001
—
PA
Enumeration date
07/21/2015
Last updated
07/21/2015
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