Provider Demographics
NPI:1528092814
Name:HOFFERT, SUSAN DENBY (PT)
Entity type:Individual
Prefix:
First Name:SUSAN
Middle Name:DENBY
Last Name:HOFFERT
Suffix:
Gender:F
Credentials:PT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:204 S. JONES BLVD
Mailing Address - Street 2:
Mailing Address - City:LAS VEGAS
Mailing Address - State:NV
Mailing Address - Zip Code:89107-2657
Mailing Address - Country:US
Mailing Address - Phone:702-366-9309
Mailing Address - Fax:702-366-0732
Practice Address - Street 1:204 S. JONES BLVD
Practice Address - Street 2:
Practice Address - City:LAS VEGAS
Practice Address - State:NV
Practice Address - Zip Code:89107-2657
Practice Address - Country:US
Practice Address - Phone:702-366-9309
Practice Address - Fax:702-366-0732
Is Sole Proprietor?:No
Enumeration Date:2006-07-10
Last Update Date:2011-03-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NV0508225100000X
NV508225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist
Provider Identifiers
StateIdentifier IDID TypeIssuer
NV003402057Medicaid
NV003402057Medicaid
NVP43444Medicare UPIN