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General NPI Number Information
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NPI Number | 1689948556
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Entity Type | Individual
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Provider Name | MS. ANITA ELLEN SHIPLEY
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Gender | Female
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Dates
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Enumeration Date | 02/23/2012
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Last Update Date | 02/23/2012
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Provider Practice Location Address
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Address Line | 66325 REDWOOD RD
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City | NORTH LIBERTY
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State | IN
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Zip | 46554-9456
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Country | US
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Telephone | 574-274-7881
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Fax |
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Provider Business Mailing Address
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Address Line | 66325 REDWOOD RD
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City | NORTH LIBERTY
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State | IN
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Zip | 46554-9456
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Country | US
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Telephone | 574-274-7881
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Fax |
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 225200000X
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Taxonomy Name | Physical Therapy Assistant
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License Number | 2086360
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License Number State | TX
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Taxonomy #2
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Taxonomy Code | 225200000X
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Taxonomy Name | Physical Therapy Assistant
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License Number | TEI003078
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License Number State | PA
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Taxonomy #3
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Taxonomy Code | 225200000X
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Taxonomy Name | Physical Therapy Assistant
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License Number | 06004034A
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License Number State | IN
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