Healthcare Provider Details

I. General information

NPI: 1093549131
Provider Name (Legal Business Name): JILL MARIE HOPPE PTA
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 08/30/2024
Last Update Date: 08/30/2024
Certification Date: 08/30/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2900 VETERANS WAY
MELBOURNE FL
32940-8007
US

IV. Provider business mailing address

4385 WINDOVER WAY
MELBOURNE FL
32934-8518
US

V. Phone/Fax

Practice location:
  • Phone: 321-637-3788
  • Fax:
Mailing address:
  • Phone: 321-431-5370
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code225200000X
TaxonomyPhysical Therapy Assistant
License NumberPTA1492
License Number StateFL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: