Healthcare Provider Details

I. General information

NPI: 1225382393
Provider Name (Legal Business Name): STEPHEN STUART HOPKINS ATC
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 10/29/2012
Last Update Date: 06/03/2020
Certification Date: 06/03/2020
Deactivation Date:
Reactivation Date:

III. Provider practice location address

118 BENNETT DR STE 140
CARIBOU ME
04736-2052
US

IV. Provider business mailing address

118 BENNETT DR STE 140
CARIBOU ME
04736-2052
US

V. Phone/Fax

Practice location:
  • Phone: 207-498-6334
  • Fax:
Mailing address:
  • Phone: 207-498-6334
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code225200000X
TaxonomyPhysical Therapy Assistant
License NumberPA5621
License Number StateME
# 2
Primary TaxonomyN
Taxonomy Code2255A2300X
TaxonomyAthletic Trainer
License NumberAT436
License Number StateME

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: