Basic Information
| Provider Information | |||||||||
| NPI: | 1821723131 | ||||||||
| EntityType: | 1 | ||||||||
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| OrganizationName: | |||||||||
| LastName: | HOOGHUIS | ||||||||
| FirstName: | STEPHEN | ||||||||
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| Mailing Information | |||||||||
| Address1: | 2502 NE 12TH ST | ||||||||
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| City: | GAINESVILLE | ||||||||
| State: | FL | ||||||||
| PostalCode: | 326093158 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 3522269603 | ||||||||
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| Practice Location | |||||||||
| Address1: | 2400 MCKINNEY BLVD | ||||||||
| Address2: | |||||||||
| City: | COLONIAL BEACH | ||||||||
| State: | VA | ||||||||
| PostalCode: | 224431237 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 8042242222 | ||||||||
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| Other Information | |||||||||
| ProviderEnumerationDate: | 07/20/2022 | ||||||||
| LastUpdateDate: | 07/20/2022 | ||||||||
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| ProviderGenderCode: | M | ||||||||
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| IsSoleProprietor: | Y | ||||||||
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| NPICertificationDate: | 07/20/2022 | ||||||||
Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 225200000X | PTA30217 | FL | Y | Respiratory, Developmental, Rehabilitative and Restorative Service Providers | Physical Therapy Assistant |
No ID Information.