Provider Demographics
NPI:1215406426
Name:LIPOVSKY, AMELIA (LMT, CPT)
Entity Type:Individual
Prefix:
First Name:AMELIA
Middle Name:
Last Name:LIPOVSKY
Suffix:
Gender:F
Credentials:LMT, CPT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:981 ROUND LAKE RD
Mailing Address - Street 2:
Mailing Address - City:WHITE LAKE
Mailing Address - State:MI
Mailing Address - Zip Code:48386-3262
Mailing Address - Country:US
Mailing Address - Phone:248-770-1875
Mailing Address - Fax:
Practice Address - Street 1:28351 BECK RD STE G3
Practice Address - Street 2:
Practice Address - City:WIXOM
Practice Address - State:MI
Practice Address - Zip Code:48393-4752
Practice Address - Country:US
Practice Address - Phone:248-770-1875
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2018-11-16
Last Update Date:2022-04-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI7501003674225700000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225700000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersMassage Therapist