Provider Demographics
NPI:1386846327
Name:ZIPSE, RICHIE (LMT,PTA)
Entity Type:Individual
Prefix:
First Name:RICHIE
Middle Name:
Last Name:ZIPSE
Suffix:
Gender:M
Credentials:LMT,PTA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:6180 E HAWTHORNE ST
Mailing Address - Street 2:
Mailing Address - City:TUCSON
Mailing Address - State:AZ
Mailing Address - Zip Code:85711-1627
Mailing Address - Country:US
Mailing Address - Phone:520-300-1351
Mailing Address - Fax:
Practice Address - Street 1:6180 E HAWTHORNE ST
Practice Address - Street 2:
Practice Address - City:TUCSON
Practice Address - State:AZ
Practice Address - Zip Code:85711-1627
Practice Address - Country:US
Practice Address - Phone:520-300-1351
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2007-06-01
Last Update Date:2014-02-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AZ7682A225200000X
AZ#MT-15040172M00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes172M00000XOther Service ProvidersMechanotherapist
No225200000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapy Assistant