Healthcare Provider Details

I. General information

NPI: 1083083836
Provider Name (Legal Business Name): ERICA ALLYNE ZIPPEL DPT
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 09/23/2015
Last Update Date: 09/30/2021
Certification Date: 09/30/2021
Deactivation Date:
Reactivation Date:

III. Provider practice location address

413 SEXTON CIR
ELLIJAY GA
30540-1462
US

IV. Provider business mailing address

413 SEXTON CIR
ELLIJAY GA
30540-1462
US

V. Phone/Fax

Practice location:
  • Phone: 904-718-8732
  • Fax:
Mailing address:
  • Phone: 904-718-8732
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code225100000X
TaxonomyPhysical Therapist
License Number8030
License Number StateSC
# 2
Primary TaxonomyY
Taxonomy Code225100000X
TaxonomyPhysical Therapist
License NumberPT012138
License Number StateGA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: