Provider Demographics
NPI:1538494919
Name:LIPSEN, DEBORA PYNE (PT)
Entity Type:Individual
Prefix:MRS
First Name:DEBORA
Middle Name:PYNE
Last Name:LIPSEN
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 1:2887 TRAILWOOD DR SE
Mailing Address - Street 2:
Mailing Address - City:SOUTHPORT
Mailing Address - State:NC
Mailing Address - Zip Code:28461-8493
Mailing Address - Country:US
Mailing Address - Phone:910-805-3016
Mailing Address - Fax:
Practice Address - Street 1:630 N FODALE AVE
Practice Address - Street 2:
Practice Address - City:SOUTHPORT
Practice Address - State:NC
Practice Address - Zip Code:28461-3538
Practice Address - Country:US
Practice Address - Phone:910-457-9581
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2009-10-02
Last Update Date:2009-10-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC11447225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist