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General NPI Number Information
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NPI Number | 1932312824
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Entity Type | Individual
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Provider Name | ANDREA NOEL TIPPETT MPT
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Gender | Female
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Dates
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Enumeration Date | 05/07/2007
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Last Update Date | 02/13/2008
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Provider Practice Location Address
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Address Line | 4560 SOUTH BLVD SUITE 310
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City | VIRGINIA BEACH
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State | VA
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Zip | 23452-1160
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Country | US
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Telephone | 757-490-3243
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Fax |
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Provider Business Mailing Address
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Address Line | 5212 MARACAS ARCH
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City | VIRGINIA BEACH
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State | VA
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Zip | 23462-1977
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Country | US
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Telephone | 757-642-6258
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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 | 225100000X
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Taxonomy Name | Physical Therapist
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License Number | 2305204466
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License Number State | VA
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