Provider Demographics
NPI:1073979142
Name:LIPSCOMB, CAITLIN BECK (PT, DPT)
Entity Type:Individual
Prefix:
First Name:CAITLIN
Middle Name:BECK
Last Name:LIPSCOMB
Suffix:
Gender:F
Credentials:PT, DPT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:654 HIGHLAND AVE STE 17
Mailing Address - Street 2:
Mailing Address - City:FORT THOMAS
Mailing Address - State:KY
Mailing Address - Zip Code:41075-1762
Mailing Address - Country:US
Mailing Address - Phone:859-802-9317
Mailing Address - Fax:
Practice Address - Street 1:654 HIGHLAND AVE STE 17
Practice Address - Street 2:
Practice Address - City:FORT THOMAS
Practice Address - State:KY
Practice Address - Zip Code:41075-1762
Practice Address - Country:US
Practice Address - Phone:859-802-9317
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2016-01-05
Last Update Date:2020-04-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH015299225100000X
KY006604225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist