Provider Demographics
NPI:1083336028
Name:CRIPE, MARCIA MARIE (LMT)
Entity Type:Individual
Prefix:
First Name:MARCIA
Middle Name:MARIE
Last Name:CRIPE
Suffix:
Gender:F
Credentials:LMT
Other - Prefix:
Other - First Name:MARCIA MARIE
Other - Middle Name:CRIPE
Other - Last Name:FOX
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:LMT
Mailing Address - Street 1:2630 SEVERANCE ST APT 3B
Mailing Address - Street 2:
Mailing Address - City:LOS ANGELES
Mailing Address - State:CA
Mailing Address - Zip Code:90007-2500
Mailing Address - Country:US
Mailing Address - Phone:512-988-4040
Mailing Address - Fax:
Practice Address - Street 1:2630 SEVERANCE ST APT 3B
Practice Address - Street 2:
Practice Address - City:LOS ANGELES
Practice Address - State:CA
Practice Address - Zip Code:90007-2500
Practice Address - Country:US
Practice Address - Phone:512-988-4040
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2022-09-15
Last Update Date:2022-09-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX113904225700000X
CA88409225700000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225700000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersMassage Therapist