Provider Demographics
NPI:1174865299
Name:BIPPERT, MAKENZIE W (PT)
Entity Type:Individual
Prefix:
First Name:MAKENZIE
Middle Name:W
Last Name:BIPPERT
Suffix:
Gender:F
Credentials:PT
Other - Prefix:
Other - First Name:MAKENZIE
Other - Middle Name:
Other - Last Name:MCDONALD
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:
Mailing Address - Street 1:2829 BABCOCK ROAD
Mailing Address - Street 2:SUITE 710
Mailing Address - City:SAN ANTONIO
Mailing Address - State:TX
Mailing Address - Zip Code:78229-6015
Mailing Address - Country:US
Mailing Address - Phone:210-804-5400
Mailing Address - Fax:210-396-5271
Practice Address - Street 1:2829 BABCOCK ROAD
Practice Address - Street 2:SUITE 710
Practice Address - City:SAN ANTONIO
Practice Address - State:TX
Practice Address - Zip Code:78229-6015
Practice Address - Country:US
Practice Address - Phone:210-804-5400
Practice Address - Fax:210-396-5271
Is Sole Proprietor?:No
Enumeration Date:2013-03-27
Last Update Date:2013-03-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX1208310225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist