Provider Demographics
NPI:1750798930
Name:HOPPIS, SHELBY (ATC, LAT)
Entity type:Individual
Prefix:
First Name:SHELBY
Middle Name:
Last Name:HOPPIS
Suffix:
Gender:F
Credentials:ATC, LAT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:535 MAIN ST APT 17
Mailing Address - Street 2:
Mailing Address - City:BETHLEHEM
Mailing Address - State:PA
Mailing Address - Zip Code:18018-5839
Mailing Address - Country:US
Mailing Address - Phone:650-452-3503
Mailing Address - Fax:
Practice Address - Street 1:PRINCETON UNIVERSITY
Practice Address - Street 2:CALDWELL FIELDHOUSE
Practice Address - City:PRINCETON
Practice Address - State:NJ
Practice Address - Zip Code:08544-0001
Practice Address - Country:US
Practice Address - Phone:609-258-3527
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2014-07-19
Last Update Date:2014-07-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PART0053612255A2300X
NJ25MT001890002255A2300X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2255A2300XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersSpecialist/TechnologistAthletic Trainer