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NPI Code Detail

MEDICARE: BRIANNA LIPPS PTA

MEDICARE: BRIANNA LIPPS 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 Assistant2119383TX

General Provider Information

NPI Number : 1881114817
Entity Type Code : Individual
Provider Name (Legal Business Name) : BRIANNA LIPPS PTA
Provider Business Mailing Address
First Line : 4510 IRONTON AVE APT 12211
Second Line :
City : LUBBOCK
State : TX
Zip : 79407-3816
Country : US
Telephone Number : 308-430-5207
Fax Number :
Provider Business Practice Location Address
First Line : 1106 ALSTON AVE STE 120
Second Line :
City : FORT WORTH
State : TX
Zip : 76104-4622
Country : US
Telephone Number : 817-332-0660
Fax Number :
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 06/21/2017
Last Update Date : 06/21/2017

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Directions to “ BRIANNA LIPPS PTA” Practice Location

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