Basic Information
| Provider Information | |||||||||
| NPI: | 1609331008 | ||||||||
| EntityType: | 1 | ||||||||
| ReplacementNPI: | |||||||||
| OrganizationName: | |||||||||
| LastName: | HOFFNER | ||||||||
| FirstName: | COREY | ||||||||
| MiddleName: | MATTHEW | ||||||||
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| Credential: | DPT, CSCS | ||||||||
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| Mailing Information | |||||||||
| Address1: | 43 TRAM DR | ||||||||
| Address2: | |||||||||
| City: | OXFORD | ||||||||
| State: | CT | ||||||||
| PostalCode: | 064781845 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 2034375077 | ||||||||
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| Practice Location | |||||||||
| Address1: | 305 BLACK ROCK TPKE | ||||||||
| Address2: | |||||||||
| City: | FAIRFIELD | ||||||||
| State: | CT | ||||||||
| PostalCode: | 068255508 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 2033372600 | ||||||||
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| Other Information | |||||||||
| ProviderEnumerationDate: | 02/10/2019 | ||||||||
| LastUpdateDate: | 02/10/2019 | ||||||||
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| ProviderGenderCode: | M | ||||||||
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| IsSoleProprietor: | N | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 225100000X | 12123 | CT | Y | Respiratory, Developmental, Rehabilitative and Restorative Service Providers | Physical Therapist |
No ID Information.