Healthcare Provider Details

I. General information

NPI: 1871847038
Provider Name (Legal Business Name): JAKE DONALD HOEPPNER DPT
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 11/08/2012
Last Update Date: 01/28/2025
Certification Date: 01/28/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3708 BROADWAY AVE N STE 110
ROCHESTER MN
55906-4159
US

IV. Provider business mailing address

3100 19TH ST NW SUITE 200
ROCHESTER MN
55901-6606
US

V. Phone/Fax

Practice location:
  • Phone: 507-322-3460
  • Fax:
Mailing address:
  • Phone: 507-322-3460
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code2251X0800X
TaxonomyOrthopedic Physical Therapist
License Number9029
License Number StateMN

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: