Provider Demographics
NPI:1043512536
Name:LIPPOLI, JOSEPH DAVID (PTA)
Entity Type:Individual
Prefix:MR
First Name:JOSEPH
Middle Name:DAVID
Last Name:LIPPOLI
Suffix:
Gender:M
Credentials:PTA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:123 PARLIAMENT RD
Mailing Address - Street 2:
Mailing Address - City:SHADY SPRING
Mailing Address - State:WV
Mailing Address - Zip Code:25918-8432
Mailing Address - Country:US
Mailing Address - Phone:304-639-4399
Mailing Address - Fax:
Practice Address - Street 1:345 POCAHONTAS TRAIL
Practice Address - Street 2:ROUTE 92
Practice Address - City:WHITE SULPHUR SPRINGS
Practice Address - State:WV
Practice Address - Zip Code:24986
Practice Address - Country:US
Practice Address - Phone:304-536-4661
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2010-12-03
Last Update Date:2010-12-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WV001586225200000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225200000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapy Assistant