Healthcare Provider Details

I. General information

NPI: 1063864403
Provider Name (Legal Business Name): JENNIFER RIPPETOE LAWRENCE MS, ATC
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 07/11/2016
Last Update Date: 07/11/2016
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

4267 TURNBERRY RD
LEBANON TN
37090-6503
US

IV. Provider business mailing address

4267 TURNBERRY RD
LEBANON TN
37090-6503
US

V. Phone/Fax

Practice location:
  • Phone: 615-618-2718
  • Fax:
Mailing address:
  • Phone: 615-618-2718
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code246Z00000X
TaxonomyOther Specialist/Technologist
License Number284
License Number StateTN

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: