Provider Demographics
NPI:1467549956
Name:HOOPER, ELISSA SUZANNE (ATC)
Entity Type:Individual
Prefix:
First Name:ELISSA
Middle Name:SUZANNE
Last Name:HOOPER
Suffix:
Gender:F
Credentials:ATC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:718 GREEN RIDGE PKWY
Mailing Address - Street 2:APT B
Mailing Address - City:BROWNSBURG
Mailing Address - State:IN
Mailing Address - Zip Code:46112-2446
Mailing Address - Country:US
Mailing Address - Phone:217-495-1577
Mailing Address - Fax:
Practice Address - Street 1:5949 W RAYMOND ST
Practice Address - Street 2:
Practice Address - City:INDIANAPOLIS
Practice Address - State:IN
Practice Address - Zip Code:46241-4348
Practice Address - Country:US
Practice Address - Phone:317-390-5590
Practice Address - Fax:317-486-2194
Is Sole Proprietor?:No
Enumeration Date:2006-10-06
Last Update Date:2014-12-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL096.0019462255A2300X
IN360010277A2255A2300X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2255A2300XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersSpecialist/TechnologistAthletic Trainer