Healthcare Provider Details

I. General information

NPI: 1154032910
Provider Name (Legal Business Name): MARCUS RIPLEY MPT
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 12/12/2022
Last Update Date: 12/12/2022
Certification Date: 12/12/2022
Deactivation Date:
Reactivation Date:

III. Provider practice location address

321 W BEN WHITE BLVD STE 101
AUSTIN TX
78704-7086
US

IV. Provider business mailing address

1033 LA POSADA DR STE 230
AUSTIN TX
78752-3842
US

V. Phone/Fax

Practice location:
  • Phone: 512-215-9272
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code225100000X
TaxonomyPhysical Therapist
License Number1363717
License Number StateTX

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: