Provider Demographics
NPI:1003125675
Name:HOPPER, ALICE A (DPT)
Entity Type:Individual
Prefix:
First Name:ALICE
Middle Name:A
Last Name:HOPPER
Suffix:
Gender:F
Credentials:DPT
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Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
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Other - Credentials:
Mailing Address - Street 1:P.O. DRAWER PH
Mailing Address - Street 2:CHINLE COMPREHENSIVE HEALTH CARE FACILITY
Mailing Address - City:CHINLE
Mailing Address - State:AZ
Mailing Address - Zip Code:86503
Mailing Address - Country:US
Mailing Address - Phone:928-674-7552
Mailing Address - Fax:928-674-7705
Practice Address - Street 1:HIGHWAY 191 AND HOSPITAL ROAD
Practice Address - Street 2:CHINLE COMPREHENSIVE HEALTH CARE FACILITY
Practice Address - City:CHINLE
Practice Address - State:AZ
Practice Address - Zip Code:86503
Practice Address - Country:US
Practice Address - Phone:928-674-7552
Practice Address - Fax:928-674-7705
Is Sole Proprietor?:No
Enumeration Date:2010-09-30
Last Update Date:2010-09-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NCP11407225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist
Provider Identifiers
StateIdentifier IDID TypeIssuer
NCP11407OtherSTATE