Healthcare Provider Details

I. General information

NPI: 1982989455
Provider Name (Legal Business Name): COREEN WHIPPLE LPTA
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 10/17/2011
Last Update Date: 10/17/2011
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

600 S. FRANKLIN
ELK POINT SD
57025
US

IV. Provider business mailing address

PO BOX 358
ELK POINT SD
57025-0358
US

V. Phone/Fax

Practice location:
  • Phone: 605-356-2622
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code225200000X
TaxonomyPhysical Therapy Assistant
License Number004816
License Number StateIA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: