Healthcare Provider Details

I. General information

NPI: 1932488236
Provider Name (Legal Business Name): JOSHUA A NIPPER ATP
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 08/04/2011
Last Update Date: 08/05/2011
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

12015 SHILOH RD STE 158B
DALLAS TX
75228-1596
US

IV. Provider business mailing address

12015 SHILOH RD STE 158B
DALLAS TX
75228-1596
US

V. Phone/Fax

Practice location:
  • Phone: 214-319-7772
  • Fax: 214-319-9411
Mailing address:
  • Phone: 214-319-7772
  • Fax: 214-319-9411

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code225CA2500X
TaxonomyAssistive Technology Supplier Rehabilitation Counselor
License NumberATP47600
License Number StateIL
# 2
Primary TaxonomyY
Taxonomy Code247200000X
TaxonomyOther Technician
License NumberATP47600
License Number StateIL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: