Provider Demographics
NPI:1326826447
Name:HOPPENJANS, NOLAN (DPT, CSCS)
Entity Type:Individual
Prefix:
First Name:NOLAN
Middle Name:
Last Name:HOPPENJANS
Suffix:
Gender:M
Credentials:DPT, CSCS
Other - Prefix:
Other - First Name:NOLAN
Other - Middle Name:
Other - Last Name:DREYER
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:540 LINDLEY TER
Mailing Address - Street 2:
Mailing Address - City:PORT CHARLOTTE
Mailing Address - State:FL
Mailing Address - Zip Code:33952-8355
Mailing Address - Country:US
Mailing Address - Phone:859-446-6551
Mailing Address - Fax:
Practice Address - Street 1:2328 HANCOCK BRIDGE PKWY STE 103
Practice Address - Street 2:
Practice Address - City:CAPE CORAL
Practice Address - State:FL
Practice Address - Zip Code:33990-1455
Practice Address - Country:US
Practice Address - Phone:239-574-7557
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2023-09-19
Last Update Date:2023-11-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FL40884225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist