Healthcare Provider Details

I. General information

NPI: 1841015435
Provider Name (Legal Business Name): ERYKAH KIPF
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 11/19/2024
Last Update Date: 11/19/2024
Certification Date: 11/19/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

25 W CRYSTAL LAKE ST STE 200
ORLANDO FL
32806-4476
US

IV. Provider business mailing address

635 CENTURY PT STE 111
LAKE MARY FL
32746-2139
US

V. Phone/Fax

Practice location:
  • Phone: 407-578-5252
  • Fax:
Mailing address:
  • Phone: 407-792-0031
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code225200000X
TaxonomyPhysical Therapy Assistant
License Number33764
License Number StateFL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: