Provider Demographics
NPI:1467923060
Name:LIPON, DOREEN ANN (PT)
Entity Type:Individual
Prefix:MRS
First Name:DOREEN
Middle Name:ANN
Last Name:LIPON
Suffix:
Gender:F
Credentials:PT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:5115 E ALLEN RD
Mailing Address - Street 2:
Mailing Address - City:HOWELL
Mailing Address - State:MI
Mailing Address - Zip Code:48855-9248
Mailing Address - Country:US
Mailing Address - Phone:517-304-1553
Mailing Address - Fax:
Practice Address - Street 1:5115 E ALLEN RD
Practice Address - Street 2:
Practice Address - City:HOWELL
Practice Address - State:MI
Practice Address - Zip Code:48855-9248
Practice Address - Country:US
Practice Address - Phone:517-304-1553
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2018-12-08
Last Update Date:2018-12-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI5501003494225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist