Provider Demographics
NPI:1043343510
Name:LIPSCOMBE, MARY YOUNG (PT)
Entity Type:Individual
Prefix:
First Name:MARY
Middle Name:YOUNG
Last Name:LIPSCOMBE
Suffix:
Gender:F
Credentials:PT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:8626 OAKCROFT RD
Mailing Address - Street 2:
Mailing Address - City:RICHMOND
Mailing Address - State:VA
Mailing Address - Zip Code:23229-7232
Mailing Address - Country:US
Mailing Address - Phone:804-741-4837
Mailing Address - Fax:
Practice Address - Street 1:4101 NINE MILE RD
Practice Address - Street 2:
Practice Address - City:RICHMOND
Practice Address - State:VA
Practice Address - Zip Code:23223-4916
Practice Address - Country:US
Practice Address - Phone:804-222-1694
Practice Address - Fax:804-222-1164
Is Sole Proprietor?:Yes
Enumeration Date:2007-03-14
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA2305001094225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist