Provider Demographics
NPI:1689473712
Name:HOFSTETTER, LYDIA ROSE
Entity type:Individual
Prefix:
First Name:LYDIA
Middle Name:ROSE
Last Name:HOFSTETTER
Suffix:
Gender:
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2230 ASHLEY CROSSING DR
Mailing Address - Street 2:
Mailing Address - City:CHARLESTON
Mailing Address - State:SC
Mailing Address - Zip Code:29414-5700
Mailing Address - Country:US
Mailing Address - Phone:843-701-6402
Mailing Address - Fax:
Practice Address - Street 1:2230 ASHLEY CROSSING DR
Practice Address - Street 2:
Practice Address - City:CHARLESTON
Practice Address - State:SC
Practice Address - Zip Code:29414-5700
Practice Address - Country:US
Practice Address - Phone:843-701-6402
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2025-03-11
Last Update Date:2025-03-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225200000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapy Assistant