Basic Information
Provider Information | |||||||||
NPI: | 1801896501 | ||||||||
EntityType: | 1 | ||||||||
ReplacementNPI: |   | ||||||||
OrganizationName: |   | ||||||||
LastName: | HOFFPAUIR | ||||||||
FirstName: | KERRY | ||||||||
MiddleName: | COCKRELL | ||||||||
NamePrefix: | MRS. | ||||||||
NameSuffix: |   | ||||||||
Credential: | PT | ||||||||
OtherOrganizationName: |   | ||||||||
OtherOrganizationType: |   | ||||||||
OtherLastName: |   | ||||||||
OtherFirstName: |   | ||||||||
OtherMiddleName: |   | ||||||||
OtherNamePrefix: |   | ||||||||
OtherNameSuffix: |   | ||||||||
OtherCredential: |   | ||||||||
OtherLastNameType: |   | ||||||||
Mailing Information | |||||||||
Address1: | 1103 CYPRESS CREEK RD | ||||||||
Address2: | STE 103 | ||||||||
City: | CEDAR PARK | ||||||||
State: | TX | ||||||||
PostalCode: | 786133924 | ||||||||
CountryCode: | US | ||||||||
TelephoneNumber: | 5129180044 | ||||||||
FaxNumber: | 5129180045 | ||||||||
Practice Location | |||||||||
Address1: | 1103 CYPRESS CREEK RD | ||||||||
Address2: | STE 103 | ||||||||
City: | CEDAR PARK | ||||||||
State: | TX | ||||||||
PostalCode: | 786133924 | ||||||||
CountryCode: | US | ||||||||
TelephoneNumber: | 5129180044 | ||||||||
FaxNumber: | 5129180045 | ||||||||
Other Information | |||||||||
ProviderEnumerationDate: | 07/26/2005 | ||||||||
LastUpdateDate: | 04/10/2008 | ||||||||
NPIDeactivationReasonCode: |   | ||||||||
NPIDeactivationDate: |   | ||||||||
NPIReactivationDate: |   | ||||||||
ProviderGenderCode: | F | ||||||||
AuthorizedOfficialLastName: |   | ||||||||
AuthorizedOfficialFirstName: |   | ||||||||
AuthorizedOfficialMiddleName: |   | ||||||||
AuthorizedOfficialTitleorPosition: |   | ||||||||
AuthorizedOfficialTelephone: |   | ||||||||
IsSoleProprietor: | N | ||||||||
IsOrganizationSubpart: |   | ||||||||
ParentOrganizationLBN: |   | ||||||||
AuthorizedOfficialNamePrefix: |   | ||||||||
AuthorizedOfficialNameSuffix: |   | ||||||||
AuthorizedOfficialCredential: |   | ||||||||
NPICertificationDate: |   |
Taxonomy Information
Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 225100000X | 1142826 | TX | Y |   | Respiratory, Developmental, Rehabilitative and Restorative Service Providers | Physical Therapist |   |
ID Information
ID | Type | State | Issuer | Description | 8T6386 | 01 | TX | BCBS | OTHER |