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NPI Code Detail

MEDICARE: KENT LIPPERT PTA

MEDICARE: KENT LIPPERT PTA
Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

# Taxonomy Code Taxonomy License Number License Number State
1225200000XPhysical Therapy Assistant14121FL

General Provider Information

NPI Number : 1497879969
Entity Type Code : Individual
Provider Name (Legal Business Name) : KENT LIPPERT PTA
Provider Business Mailing Address
First Line : PO BOX 1154
Second Line :
City : MELBOURNE
State : FL
Zip : 32902-1154
Country : US
Telephone Number : 321-848-2066
Fax Number :
Provider Business Practice Location Address
First Line : 333 1ST ST N
Second Line : SUITE 2001
City : JACKSONVILLE BEACH
State : FL
Zip : 32250-6945
Country : US
Telephone Number : 800-920-5038
Fax Number :
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 03/19/2007
Last Update Date : 07/08/2007

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Directions to “ KENT LIPPERT PTA” Practice Location

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