Healthcare Provider Details

I. General information

NPI: 1851780159
Provider Name (Legal Business Name): CELESTE DAWN SCHIPPER
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 01/10/2015
Last Update Date: 01/10/2015
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

915 CRENSHAW BLVD
LOS ANGELES CA
90019-1938
US

IV. Provider business mailing address

915 CRENSHAW BLVD
LOS ANGELES CA
90019-1938
US

V. Phone/Fax

Practice location:
  • Phone: 323-937-5466
  • Fax:
Mailing address:
  • Phone: 323-937-5466
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code225200000X
TaxonomyPhysical Therapy Assistant
License Number3070
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: