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General NPI Number Information
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NPI Number | 1063292571
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Entity Type | Individual
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Provider Name | MASON HOEPER
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Gender | Male
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Dates
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Enumeration Date | 10/02/2023
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Last Update Date | 10/02/2023
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Provider Practice Location Address
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Address Line | 244 N MACY ST
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City | FOND DU LAC
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State | WI
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Zip | 54935-3362
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Country | US
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Telephone | 920-921-9520
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Fax |
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Provider Business Mailing Address
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Address Line | 966 ZEMLOCK AVE
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City | NEENAH
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State | WI
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Zip | 54956-3732
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Country | US
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Telephone | 920-858-6793
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Fax |
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 225200000X
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Taxonomy Name | Physical Therapy Assistant
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License Number | 4100-19
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License Number State | WI
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