MEDICARE: JANEL GRACE HOOPER PT

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	225100000X	Physical Therapist	40QA01199900	NJ

General Provider Information

NPI Number	:	1912254756
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	JANEL GRACE HOOPER PT

Provider Business Mailing Address
First Line	:	33 MOUNTAIN VIEW AVENUE
Second Line	:
City	:	LONG VALLEY
State	:	NJ
Zip	:	07853-1306
Country	:	US
Telephone Number	:
Fax Number	:

Provider Business Practice Location Address
First Line	:	33 MOUNTAIN VIEW AVENUE
Second Line	:
City	:	LONG VALLEY
State	:	NJ
Zip	:	07853-1306
Country	:	US
Telephone Number	:	973-670-6693
Fax Number	:

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

Provider Enumeration Date	:	08/11/2012
Last Update Date	:	08/21/2015

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Directions to “ JANEL GRACE HOOPER PT” Practice Location

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