Provider Demographics
NPI:1063750826
Name:HOPPER, DEBORAH ROBERTS (PT)
Entity type:Individual
Prefix:MRS
First Name:DEBORAH
Middle Name:ROBERTS
Last Name:HOPPER
Suffix:
Gender:F
Credentials:PT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:142 CRESCENT RD
Mailing Address - Street 2:
Mailing Address - City:THOMASTON
Mailing Address - State:GA
Mailing Address - Zip Code:30286-7457
Mailing Address - Country:US
Mailing Address - Phone:770-550-1344
Mailing Address - Fax:
Practice Address - Street 1:142 CRESCENT RD
Practice Address - Street 2:
Practice Address - City:THOMASTON
Practice Address - State:GA
Practice Address - Zip Code:30286-7457
Practice Address - Country:US
Practice Address - Phone:770-550-1344
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2013-01-29
Last Update Date:2013-01-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GA225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist