Provider Demographics
NPI:1821186974
Name:HOPPE-STIDHAM, BETH M (PT)
Entity Type:Individual
Prefix:
First Name:BETH
Middle Name:M
Last Name:HOPPE-STIDHAM
Suffix:
Gender:F
Credentials:PT
Other - Prefix:
Other - First Name:BETH
Other - Middle Name:M
Other - Last Name:HOPPE
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:2550 UNIVERSITY AVE W
Mailing Address - Street 2:SUITE 240N
Mailing Address - City:SAINT PAUL
Mailing Address - State:MN
Mailing Address - Zip Code:55114-1052
Mailing Address - Country:US
Mailing Address - Phone:651-999-6909
Mailing Address - Fax:651-999-6830
Practice Address - Street 1:360 SHERMAN ST
Practice Address - Street 2:SUITE 400
Practice Address - City:SAINT PAUL
Practice Address - State:MN
Practice Address - Zip Code:55102-2564
Practice Address - Country:US
Practice Address - Phone:651-999-6938
Practice Address - Fax:651-702-7343
Is Sole Proprietor?:No
Enumeration Date:2006-10-11
Last Update Date:2007-09-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MN4559225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist
Provider Identifiers
StateIdentifier IDID TypeIssuer
MN725514400Medicaid