Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 225100000X | Physical Therapist | P11407 | NC |
NPI | 1003125675 |
---|---|
Provider Name | Alice A. Hopper |
First Address | Chinle, AZ 86503 |
Second Address | Chinle, AZ 86503 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 30/09/2010 |
Last Update Date | 30/09/2010 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
P11407 | STATE (01) | NC |