Provider Demographics
NPI:1710617493
Name:HOPTON, JOSHUA DENZEL (AT, ATC)
Entity Type:Individual
Prefix:
First Name:JOSHUA
Middle Name:DENZEL
Last Name:HOPTON
Suffix:
Gender:M
Credentials:AT, ATC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:18584 TIPSICO LAKE RD
Mailing Address - Street 2:
Mailing Address - City:FENTON
Mailing Address - State:MI
Mailing Address - Zip Code:48430-8417
Mailing Address - Country:US
Mailing Address - Phone:810-618-0946
Mailing Address - Fax:
Practice Address - Street 1:18584 TIPSICO LAKE RD
Practice Address - Street 2:
Practice Address - City:FENTON
Practice Address - State:MI
Practice Address - Zip Code:48430-8417
Practice Address - Country:US
Practice Address - Phone:810-618-0946
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2022-06-15
Last Update Date:2022-06-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI26010027072255A2300X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2255A2300XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersSpecialist/TechnologistAthletic Trainer