MEDICARE: MR. PHILIP HOPPER PTA

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	225200000X	Physical Therapy Assistant

General Provider Information

NPI Number	:	1760538714
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MR. PHILIP HOPPER PTA

Provider Business Mailing Address
First Line	:	762A E GLENN AVE
Second Line	:
City	:	AUBURN
State	:	AL
Zip	:	36830-5017
Country	:	US
Telephone Number	:	334-501-2290
Fax Number	:	334-501-2293

Provider Business Practice Location Address
First Line	:	762A E GLENN AVE
Second Line	:
City	:	AUBURN
State	:	AL
Zip	:	36830-5017
Country	:	US
Telephone Number	:	334-501-2290
Fax Number	:	334-501-2293

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	01/25/2007
Last Update Date	:	07/08/2007

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