Provider Demographics
NPI:1144711847
Name:RIPLEY, NOAH JAMES
Entity type:Individual
Prefix:
First Name:NOAH
Middle Name:JAMES
Last Name:RIPLEY
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1309 EDGEWOOD DR
Mailing Address - Street 2:
Mailing Address - City:KAUKAUNA
Mailing Address - State:WI
Mailing Address - Zip Code:54130-2921
Mailing Address - Country:US
Mailing Address - Phone:920-422-2105
Mailing Address - Fax:
Practice Address - Street 1:8911 N PORT WASHINGTON RD
Practice Address - Street 2:
Practice Address - City:BAYSIDE
Practice Address - State:WI
Practice Address - Zip Code:53217-1634
Practice Address - Country:US
Practice Address - Phone:414-305-7206
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2018-05-29
Last Update Date:2018-05-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WI2782225200000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225200000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapy Assistant