Provider Demographics
NPI:1033162508
Name:SIPPEL, COLETTE A (PT)
Entity Type:Individual
Prefix:MRS
First Name:COLETTE
Middle Name:A
Last Name:SIPPEL
Suffix:
Gender:F
Credentials:PT
Other - Prefix:MS
Other - First Name:COLETTE
Other - Middle Name:
Other - Last Name:RICHARDSON
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:PT
Mailing Address - Street 1:60 PELICAN BAY
Mailing Address - Street 2:
Mailing Address - City:ROSELLE
Mailing Address - State:IL
Mailing Address - Zip Code:60172-4726
Mailing Address - Country:US
Mailing Address - Phone:847-385-1981
Mailing Address - Fax:847-859-5896
Practice Address - Street 1:1320 TOWER RD
Practice Address - Street 2:SUITE 105 AND 106
Practice Address - City:SCHAUMBURG
Practice Address - State:IL
Practice Address - Zip Code:60173-4309
Practice Address - Country:US
Practice Address - Phone:847-385-1981
Practice Address - Fax:847-859-5896
Is Sole Proprietor?:Yes
Enumeration Date:2006-05-18
Last Update Date:2009-04-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL070-011253225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist
Provider Identifiers
StateIdentifier IDID TypeIssuer
ILIL1294001OtherMEDICARE PTAN