Healthcare Provider Details

I. General information

NPI: 1437247681
Provider Name (Legal Business Name): ROBERT ALAN RIPLEY RKT
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

Provider Other Name: ROBERT ALAN RIPLEY RKT

II. Dates (important events)

Enumeration Date: 10/11/2006
Last Update Date: 07/08/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

4800 MEMORIAL DR
WACO TX
76711-1329
US

IV. Provider business mailing address

436 E JOHNSON ST
HEWITT TX
76643-3425
US

V. Phone/Fax

Practice location:
  • Phone: 254-297-3364
  • Fax:
Mailing address:
  • Phone: 254-666-3599
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code226300000X
TaxonomyKinesiotherapist
License Number582
License Number StateOH

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: