Basic Information
| Provider Information | |||||||||
| NPI: | 1427573302 | ||||||||
| EntityType: | 1 | ||||||||
| ReplacementNPI: | |||||||||
| OrganizationName: | |||||||||
| LastName: | HOFFMAN | ||||||||
| FirstName: | ELLEN | ||||||||
| MiddleName: | |||||||||
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| Credential: | LMT | ||||||||
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| Mailing Information | |||||||||
| Address1: | 2108 HARRISBURG PIKE STE 315 | ||||||||
| Address2: | |||||||||
| City: | LANCASTER | ||||||||
| State: | PA | ||||||||
| PostalCode: | 176012644 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 7175443555 | ||||||||
| FaxNumber: | |||||||||
| Practice Location | |||||||||
| Address1: | 2108 HARRISBURG PIKE STE 315 | ||||||||
| Address2: | |||||||||
| City: | LANCASTER | ||||||||
| State: | PA | ||||||||
| PostalCode: | 17601 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 7175443555 | ||||||||
| FaxNumber: | 7175443560 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 08/11/2017 | ||||||||
| LastUpdateDate: | 06/09/2018 | ||||||||
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| ProviderGenderCode: | F | ||||||||
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| IsSoleProprietor: | Y | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 225700000X | MSG011062 | PA | Y | Respiratory, Developmental, Rehabilitative and Restorative Service Providers | Massage Therapist |
ID Information
| ID | Type | State | Issuer | Description | 81-3753875 | 01 | PA | THERAPEUTIC MASSAGE | OTHER |