Provider Demographics
NPI:1447649876
Name:HOPPERDIETZEL, BETTY (PTA)
Entity type:Individual
Prefix:
First Name:BETTY
Middle Name:
Last Name:HOPPERDIETZEL
Suffix:
Gender:F
Credentials:PTA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1173 RIVERBEND DR
Mailing Address - Street 2:
Mailing Address - City:HARTFORD
Mailing Address - State:WI
Mailing Address - Zip Code:53027-8605
Mailing Address - Country:US
Mailing Address - Phone:251-545-2283
Mailing Address - Fax:
Practice Address - Street 1:1173 RIVERBEND DR
Practice Address - Street 2:
Practice Address - City:HARTFORD
Practice Address - State:WI
Practice Address - Zip Code:53027-8605
Practice Address - Country:US
Practice Address - Phone:251-545-2283
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2015-01-22
Last Update Date:2015-01-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WI2111225200000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225200000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapy Assistant