Provider Demographics
NPI:1720048689
Name:HOPTA, BETHANY MICHELLE (PT)
Entity type:Individual
Prefix:
First Name:BETHANY
Middle Name:MICHELLE
Last Name:HOPTA
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 1:2109 BROADWAY
Mailing Address - Street 2:SUITE 204
Mailing Address - City:NEW YORK
Mailing Address - State:NY
Mailing Address - Zip Code:10023-2106
Mailing Address - Country:US
Mailing Address - Phone:212-799-0160
Mailing Address - Fax:212-799-0209
Practice Address - Street 1:2109 BROADWAY
Practice Address - Street 2:SUITE 204
Practice Address - City:NEW YORK
Practice Address - State:NY
Practice Address - Zip Code:10023-2106
Practice Address - Country:US
Practice Address - Phone:212-799-0160
Practice Address - Fax:212-799-0209
Is Sole Proprietor?:No
Enumeration Date:2006-03-24
Last Update Date:2013-11-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY027672225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist