Provider Demographics
NPI:1144494386
Name:HOFFMAN, CHARLES THOMAS (PHYSICAL THERAPIST)
Entity type:Individual
Prefix:
First Name:CHARLES
Middle Name:THOMAS
Last Name:HOFFMAN
Suffix:
Gender:M
Credentials:PHYSICAL THERAPIST
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:790 REMINGTON BLVD
Mailing Address - Street 2:
Mailing Address - City:BOLINGBROOK
Mailing Address - State:IL
Mailing Address - Zip Code:60440-4909
Mailing Address - Country:US
Mailing Address - Phone:630-296-2223
Mailing Address - Fax:630-759-3251
Practice Address - Street 1:202 E VAN RIPER RD
Practice Address - Street 2:SUITE 200
Practice Address - City:FOWLERVILLE
Practice Address - State:MI
Practice Address - Zip Code:48836-7947
Practice Address - Country:US
Practice Address - Phone:517-223-2100
Practice Address - Fax:517-223-2101
Is Sole Proprietor?:No
Enumeration Date:2008-04-18
Last Update Date:2015-03-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL070002822225100000X
MI5501004129225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist
Provider Identifiers
StateIdentifier IDID TypeIssuer
MIN69750107Medicare PIN
ILF400189658Medicare PIN