Healthcare Provider Details

I. General information

NPI: 1962770032
Provider Name (Legal Business Name): SUSAN BRITTON HOPPE ED.D., ATC
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 12/05/2011
Last Update Date: 08/19/2014
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1216 ORDEAN CT 170 SPORTS AND HEALTH CENTER
DULUTH MN
55812-3032
US

IV. Provider business mailing address

1216 ORDEAN CT 170 SPORTS AND HEALTH CENTER
DULUTH MN
55812-3032
US

V. Phone/Fax

Practice location:
  • Phone: 218-726-8015
  • Fax: 218-726-7787
Mailing address:
  • Phone: 218-726-8015
  • Fax: 218-726-7787

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code2255A2300X
TaxonomyAthletic Trainer
License Number1771
License Number StateMN

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: