Provider Demographics
NPI:1811459829
Name:HOFFMAN, MARK (PHD,ATC)
Entity type:Individual
Prefix:
First Name:MARK
Middle Name:
Last Name:HOFFMAN
Suffix:
Gender:M
Credentials:PHD,ATC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:745 NW CALLOWAY DR
Mailing Address - Street 2:
Mailing Address - City:CORVALLIS
Mailing Address - State:OR
Mailing Address - Zip Code:97330-9578
Mailing Address - Country:US
Mailing Address - Phone:541-829-7885
Mailing Address - Fax:
Practice Address - Street 1:745 NW CALLOWAY DR
Practice Address - Street 2:
Practice Address - City:CORVALLIS
Practice Address - State:OR
Practice Address - Zip Code:97330-9578
Practice Address - Country:US
Practice Address - Phone:541-829-7885
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2019-04-01
Last Update Date:2019-04-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
ORAT-AT-3603372255A2300X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2255A2300XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersSpecialist/TechnologistAthletic Trainer