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General NPI Number Information
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NPI Number | 1770812216
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Entity Type | Individual
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Provider Name | AMY SHIPP LAT, ATC, ITAT
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Gender | Female
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Dates
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Enumeration Date | 12/11/2009
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Last Update Date | 11/28/2017
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Provider Practice Location Address
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Address Line | 9273 N STATE ROAD 9
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City | HOPE
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State | IN
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Zip | 47246-9760
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Country | US
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Telephone | 812-546-4421
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Fax | 812-546-2005
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Provider Business Mailing Address
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Address Line | 289 SAINT CHARLES WAY
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City | WHITELAND
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State | IN
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Zip | 46184-1671
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Country | US
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Telephone | 812-344-4019
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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 | 2255A2300X
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Taxonomy Name | Athletic Trainer
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License Number | 36001373A
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License Number State | IN
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