Healthcare Provider Details

I. General information

NPI: 1811042914
Provider Name (Legal Business Name): MICHELLE R. PIPKE B.S. P. T.
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 01/25/2007
Last Update Date: 07/08/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

17999 W. SURPRISE FARMS LOOP SOUTH
SURPRISE AZ
85388
US

IV. Provider business mailing address

3637 W CHARLESTON AVE
GLENDALE AZ
85308-2808
US

V. Phone/Fax

Practice location:
  • Phone: 623-876-7388
  • Fax:
Mailing address:
  • Phone: 602-561-5213
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code174400000X
TaxonomySpecialist
License Number2536
License Number StateAZ

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: