Basic Information
Provider Information
NPI: 1003140310
EntityType: 1
ReplacementNPI:  
OrganizationName:  
LastName: HOFFMAN
FirstName: CAROLYN
MiddleName: JOYCE
NamePrefix: MS.
NameSuffix:  
Credential: DPT
OtherOrganizationName:  
OtherOrganizationType:  
OtherLastName:  
OtherFirstName:  
OtherMiddleName:  
OtherNamePrefix:  
OtherNameSuffix:  
OtherCredential:  
OtherLastNameType:  
Mailing Information
Address1: 621 E ALEXANDER ST
Address2:  
City: PLANT CITY
State: FL
PostalCode: 335637126
CountryCode: US
TelephoneNumber: 8137071509
FaxNumber: 8137547865
Practice Location
Address1: 621 E ALEXANDER ST
Address2:  
City: PLANT CITY
State: FL
PostalCode: 335637126
CountryCode: US
TelephoneNumber: 8137071509
FaxNumber: 8137547865
Other Information
ProviderEnumerationDate: 09/21/2009
LastUpdateDate: 09/21/2009
NPIDeactivationReasonCode:  
NPIDeactivationDate:  
NPIReactivationDate:  
ProviderGenderCode: F
AuthorizedOfficialLastName:  
AuthorizedOfficialFirstName:  
AuthorizedOfficialMiddleName:  
AuthorizedOfficialTitleorPosition:  
AuthorizedOfficialTelephone:  
IsSoleProprietor: N
IsOrganizationSubpart:  
ParentOrganizationLBN:  
AuthorizedOfficialNamePrefix:  
AuthorizedOfficialNameSuffix:  
AuthorizedOfficialCredential:  

Taxonomy Information
TaxonomyLicenseStateSwitchTaxonomyGroupTaxonomyTypeTaxonomyClassSubSpecialty
225100000XPT 24881FLY Respiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist 

No ID Information.


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