Provider Demographics
NPI:1437247681
Name:RIPLEY, ROBERT ALAN (RKT)
Entity Type:Individual
Prefix:MR
First Name:ROBERT
Middle Name:ALAN
Last Name:RIPLEY
Suffix:
Gender:M
Credentials:RKT
Other - Prefix:MR
Other - First Name:ROBERT
Other - Middle Name:ALAN
Other - Last Name:RIPLEY
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:RKT
Mailing Address - Street 1:436 E JOHNSON ST
Mailing Address - Street 2:
Mailing Address - City:HEWITT
Mailing Address - State:TX
Mailing Address - Zip Code:76643-3425
Mailing Address - Country:US
Mailing Address - Phone:254-666-3599
Mailing Address - Fax:
Practice Address - Street 1:4800 MEMORIAL DR
Practice Address - Street 2:
Practice Address - City:WACO
Practice Address - State:TX
Practice Address - Zip Code:76711-1329
Practice Address - Country:US
Practice Address - Phone:254-297-3364
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2006-10-11
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH582226300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes226300000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersKinesiotherapist
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX582OtherKINESIOTHERAPIST