Provider Demographics
NPI:1427716364
Name:HOFFERICA, MICHAEL THOMAS
Entity type:Individual
Prefix:
First Name:MICHAEL
Middle Name:THOMAS
Last Name:HOFFERICA
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:15430 WEST AVE
Mailing Address - Street 2:
Mailing Address - City:ORLAND PARK
Mailing Address - State:IL
Mailing Address - Zip Code:60462-4661
Mailing Address - Country:US
Mailing Address - Phone:708-460-5494
Mailing Address - Fax:708-226-2528
Practice Address - Street 1:15430 WEST AVE
Practice Address - Street 2:
Practice Address - City:ORLAND PARK
Practice Address - State:IL
Practice Address - Zip Code:60462-4661
Practice Address - Country:US
Practice Address - Phone:708-460-5494
Practice Address - Fax:708-226-2528
Is Sole Proprietor?:Yes
Enumeration Date:2021-12-07
Last Update Date:2021-12-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL070.015124225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist