Provider Demographics
NPI:1114480712
Name:HOPPENJAN, MOLLY E (PT)
Entity Type:Individual
Prefix:
First Name:MOLLY
Middle Name:E
Last Name:HOPPENJAN
Suffix:
Gender:F
Credentials:PT
Other - Prefix:
Other - First Name:MOLLY
Other - Middle Name:E
Other - Last Name:WUBBEN
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:PT
Mailing Address - Street 1:1705 DELHI STREET, LOWER LEVEL
Mailing Address - Street 2:
Mailing Address - City:DUBUQUE
Mailing Address - State:IA
Mailing Address - Zip Code:52001-5900
Mailing Address - Country:US
Mailing Address - Phone:563-582-4170
Mailing Address - Fax:563-582-4181
Practice Address - Street 1:2300 JOHN F KENNEDY RD
Practice Address - Street 2:
Practice Address - City:DUBUQUE
Practice Address - State:IA
Practice Address - Zip Code:52002-2843
Practice Address - Country:US
Practice Address - Phone:563-588-3891
Practice Address - Fax:563-588-3893
Is Sole Proprietor?:No
Enumeration Date:2019-04-10
Last Update Date:2020-01-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IA093234225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist