Provider Demographics
NPI:1154496875
Name:SIPPOS, JILL A (MPT)
Entity Type:Individual
Prefix:MRS
First Name:JILL
Middle Name:A
Last Name:SIPPOS
Suffix:
Gender:F
Credentials:MPT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1685 TEMPEST AVE
Mailing Address - Street 2:
Mailing Address - City:BOZEMAN
Mailing Address - State:MT
Mailing Address - Zip Code:59718-6107
Mailing Address - Country:US
Mailing Address - Phone:435-655-0317
Mailing Address - Fax:
Practice Address - Street 1:8757 JACKRABBIT LN
Practice Address - Street 2:
Practice Address - City:BELGRADE
Practice Address - State:MT
Practice Address - Zip Code:59714-7900
Practice Address - Country:US
Practice Address - Phone:406-388-8118
Practice Address - Fax:406-388-9916
Is Sole Proprietor?:No
Enumeration Date:2006-11-21
Last Update Date:2015-02-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
UT5312192-2401225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist
Provider Identifiers
StateIdentifier IDID TypeIssuer
UTD5297Medicaid