Provider Demographics
NPI:1467503102
Name:IPENBURG, MARION CHRISTINE (LAC, RPT)
Entity Type:Individual
Prefix:MS
First Name:MARION
Middle Name:CHRISTINE
Last Name:IPENBURG
Suffix:
Gender:F
Credentials:LAC, RPT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:721 S AVERILL AVE
Mailing Address - Street 2:
Mailing Address - City:SAN PEDRO
Mailing Address - State:CA
Mailing Address - Zip Code:90732-3813
Mailing Address - Country:US
Mailing Address - Phone:310-732-0158
Mailing Address - Fax:310-732-1358
Practice Address - Street 1:721 S AVERILL AVE
Practice Address - Street 2:
Practice Address - City:SAN PEDRO
Practice Address - State:CA
Practice Address - Zip Code:90732-3813
Practice Address - Country:US
Practice Address - Phone:310-732-0158
Practice Address - Fax:310-732-1358
Is Sole Proprietor?:Yes
Enumeration Date:2007-01-16
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAAC6850171100000X
CAPTP20262225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Not Answered171100000XOther Service ProvidersAcupuncturist
Not Answered225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist