Healthcare Provider Details

I. General information

NPI: 1275446981
Provider Name (Legal Business Name): CLAYTON GILBERT SIPPRELL
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 09/24/2026
Last Update Date: 09/24/2026
Certification Date: 09/24/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

465 S LAWRENCE BLVD
KEYSTONE HEIGHTS FL
32656-9222
US

IV. Provider business mailing address

616 N IVY AVE
FLORAHOME FL
32140-2729
US

V. Phone/Fax

Practice location:
  • Phone: 352-473-7560
  • Fax:
Mailing address:
  • Phone: 386-972-0076
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code225100000X
TaxonomyPhysical Therapist
License NumberPTT45504
License Number StateFL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: