Provider Demographics
NPI:1205028172
Name:PIPER, CLARISSAL RAE (PTA)
Entity Type:Individual
Prefix:MS
First Name:CLARISSAL
Middle Name:RAE
Last Name:PIPER
Suffix:
Gender:F
Credentials:PTA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:300 YOUNG STREET
Mailing Address - Street 2:
Mailing Address - City:UNIONTOWN
Mailing Address - State:KY
Mailing Address - Zip Code:42461
Mailing Address - Country:US
Mailing Address - Phone:270-389-3513
Mailing Address - Fax:270-389-4702
Practice Address - Street 1:300 YOUNG STREET
Practice Address - Street 2:
Practice Address - City:UNIONTOWN
Practice Address - State:KY
Practice Address - Zip Code:42461
Practice Address - Country:US
Practice Address - Phone:270-389-3513
Practice Address - Fax:270-389-4702
Is Sole Proprietor?:No
Enumeration Date:2007-08-15
Last Update Date:2007-08-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KYA01193225200000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225200000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapy Assistant
Provider Identifiers
StateIdentifier IDID TypeIssuer
KY12500765Medicaid