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NPI Code Detail

MEDICARE: DR. LUCAS REID BOPP DPT

MEDICARE: DR. LUCAS REID BOPP DPT
Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

# Taxonomy Code Taxonomy License Number License Number State
1225100000XPhysical Therapist1700ND

General Provider Information

NPI Number : 1144641036
Entity Type Code : Individual
Provider Name (Legal Business Name) : DR. LUCAS REID BOPP DPT
Provider Business Mailing Address
First Line : PO BOX 6001
Second Line :
City : FARGO
State : ND
Zip : 58108-6001
Country : US
Telephone Number : 701-364-3300
Fax Number :
Provider Business Practice Location Address
First Line : 132 4TH AVE NE
Second Line :
City : VALLEY CITY
State : ND
Zip : 58072-3056
Country : US
Telephone Number : 701-845-8060
Fax Number :
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 12/19/2013
Last Update Date : 06/24/2020

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