Provider Demographics
NPI:1407029614
Name:SHIPPY, BETTY SUE (PT)
Entity Type:Individual
Prefix:MRS
First Name:BETTY
Middle Name:SUE
Last Name:SHIPPY
Suffix:
Gender:F
Credentials:PT
Other - Prefix:
Other - First Name:BETSY
Other - Middle Name:SUE
Other - Last Name:SHIPPY
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:PT
Mailing Address - Street 1:29307 321ST AVE
Mailing Address - Street 2:
Mailing Address - City:COLOME
Mailing Address - State:SD
Mailing Address - Zip Code:57528-6009
Mailing Address - Country:US
Mailing Address - Phone:605-842-3967
Mailing Address - Fax:
Practice Address - Street 1:29307 321ST AVE
Practice Address - Street 2:
Practice Address - City:COLOME
Practice Address - State:SD
Practice Address - Zip Code:57528-6009
Practice Address - Country:US
Practice Address - Phone:605-842-3967
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2008-04-08
Last Update Date:2008-04-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NE2069225100000X
SD0580225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist