Provider Demographics
NPI:1952478091
Name:HOPE, ETHAN W (PT)
Entity Type:Individual
Prefix:MR
First Name:ETHAN
Middle Name:W
Last Name:HOPE
Suffix:
Gender:M
Credentials:PT
Other - Prefix:MR
Other - First Name:ETHAN
Other - Middle Name:W
Other - Last Name:JEROME
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:2001 COMMONWEALTH AVE APT 8
Mailing Address - Street 2:
Mailing Address - City:BRIGHTON
Mailing Address - State:MA
Mailing Address - Zip Code:02135-5132
Mailing Address - Country:US
Mailing Address - Phone:617-894-1022
Mailing Address - Fax:
Practice Address - Street 1:75 FRANCIS ST
Practice Address - Street 2:
Practice Address - City:BOSTON
Practice Address - State:MA
Practice Address - Zip Code:02115-6110
Practice Address - Country:US
Practice Address - Phone:617-732-5304
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2006-11-30
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MA16420225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist