Provider Demographics
NPI:1508059023
Name:HOPPER PHYSICAL THERAPY, LLC
Entity Type:Organization
Organization Name:HOPPER PHYSICAL THERAPY, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER/PHYSICAL THERAPIST
Authorized Official - Prefix:MRS
Authorized Official - First Name:MARCEE
Authorized Official - Middle Name:W
Authorized Official - Last Name:HOPPER
Authorized Official - Suffix:
Authorized Official - Credentials:PHYSICAL THERAPIST
Authorized Official - Phone:606-526-1019
Mailing Address - Street 1:PO BOX 1740
Mailing Address - Street 2:
Mailing Address - City:CORBIN
Mailing Address - State:KY
Mailing Address - Zip Code:40702-1740
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
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-08-20
Last Update Date:2007-08-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KY002056261QP2000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QP2000XAmbulatory Health Care FacilitiesClinic/CenterPhysical Therapy
Provider Identifiers
StateIdentifier IDID TypeIssuer
KY000000279620OtherANTHEM
KYR40153Medicare UPIN
KY000000279620OtherANTHEM