Healthcare Provider Details

I. General information

NPI: 1932183787
Provider Name (Legal Business Name): BENJAMIN LIPPE MPT
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 12/05/2005
Last Update Date: 03/16/2009
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

533 W COLUMBIA ST
EVANSVILLE IN
47710-1617
US

IV. Provider business mailing address

7300 E INDIANA ST STE. 102
EVANSVILLE IN
47715-2794
US

V. Phone/Fax

Practice location:
  • Phone: 812-759-3001
  • Fax: 812-401-9013
Mailing address:
  • Phone: 812-476-0409
  • Fax: 812-476-1016

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code225100000X
TaxonomyPhysical Therapist
License Number05005650A
License Number StateIN
# 2
Primary TaxonomyN
Taxonomy Code225100000X
TaxonomyPhysical Therapist
License Number005391
License Number StateKY

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: