Provider Demographics
NPI:1164419289
Name:HOPPER, MARCEE WATKINS (PT)
Entity Type:Individual
Prefix:MRS
First Name:MARCEE
Middle Name:WATKINS
Last Name:HOPPER
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 1:1805 S MAIN ST
Mailing Address - Street 2:SUITE 5
Mailing Address - City:CORBIN
Mailing Address - State:KY
Mailing Address - Zip Code:40701-2406
Mailing Address - Country:US
Mailing Address - Phone:606-526-1019
Mailing Address - Fax:606-526-1038
Practice Address - Street 1:1805 S MAIN ST
Practice Address - Street 2:SUITE 5
Practice Address - City:CORBIN
Practice Address - State:KY
Practice Address - Zip Code:40701-2406
Practice Address - Country:US
Practice Address - Phone:606-526-1019
Practice Address - Fax:606-526-1038
Is Sole Proprietor?:Yes
Enumeration Date:2005-10-04
Last Update Date:2011-11-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KY2056225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist
Provider Identifiers
StateIdentifier IDID TypeIssuer
KY0759901Medicare UPIN