Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 2251P0200X | Physical Therapist - Pediatrics | 17078 | NC |
NPI | 1134649692 |
---|---|
Provider Name | Laura Hopper |
First Address | Gastonia, NC 28054-1478 |
Second Address | Gastonia, NC 28054-1478 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 26/06/2017 |
Last Update Date | 26/06/2017 |