Provider Demographics
NPI:1952966988
Name:HOPKINS, MALLORIE B
Entity Type:Individual
Prefix:
First Name:MALLORIE
Middle Name:B
Last Name:HOPKINS
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:7105 WATCHER ST
Mailing Address - Street 2:
Mailing Address - City:COMMERCE
Mailing Address - State:CA
Mailing Address - Zip Code:90040-3808
Mailing Address - Country:US
Mailing Address - Phone:562-544-9862
Mailing Address - Fax:
Practice Address - Street 1:7105 WATCHER ST
Practice Address - Street 2:
Practice Address - City:COMMERCE
Practice Address - State:CA
Practice Address - Zip Code:90040-3808
Practice Address - Country:US
Practice Address - Phone:562-544-9862
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2019-05-06
Last Update Date:2019-05-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
COPTL0016259225100000X
NJ40QA01853000225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist