Healthcare Provider Details

I. General information

NPI: 1467608950
Provider Name (Legal Business Name): THE CENTER FOR SPORTS MEDICINE, BRIAN J. SHIPLE D.O., LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 08/15/2008
Last Update Date: 06/09/2010
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

905 W SPROUL RD SUITE 106
SPRINGFIELD PA
19064-1254
US

IV. Provider business mailing address

905 W SPROUL RD SUITE 106
SPRINGFIELD PA
19064-1254
US

V. Phone/Fax

Practice location:
  • Phone: 484-472-8812
  • Fax: 484-472-8878
Mailing address:
  • Phone: 484-472-8812
  • Fax: 484-472-8878

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207QS0010X
TaxonomySports Medicine (Family Medicine) Physician
License Number
License Number State

VIII. Authorized Official

Name: DR. BRIAN J. SHIPLE
Title or Position: OWNER
Credential: D.O.
Phone: 484-472-8812