Provider Demographics
NPI:1144785767
Name:SCHOPP, WILLIAM (DPT)
Entity Type:Individual
Prefix:
First Name:WILLIAM
Middle Name:
Last Name:SCHOPP
Suffix:
Gender:M
Credentials:DPT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1620 W WYCLIFF PL
Mailing Address - Street 2:
Mailing Address - City:SAN PEDRO
Mailing Address - State:CA
Mailing Address - Zip Code:90732-3738
Mailing Address - Country:US
Mailing Address - Phone:310-508-3790
Mailing Address - Fax:
Practice Address - Street 1:291 W 22ND ST STE 104
Practice Address - Street 2:
Practice Address - City:SAN PEDRO
Practice Address - State:CA
Practice Address - Zip Code:90731-7247
Practice Address - Country:US
Practice Address - Phone:310-544-6264
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2019-02-07
Last Update Date:2020-08-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA296314225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist