Provider Demographics
NPI:1548740905
Name:TIPTON, LENA B (PTA)
Entity Type:Individual
Prefix:
First Name:LENA
Middle Name:B
Last Name:TIPTON
Suffix:
Gender:F
Credentials:PTA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:644 ABINGTON DR NE
Mailing Address - Street 2:
Mailing Address - City:CONCORD
Mailing Address - State:NC
Mailing Address - Zip Code:28025-2568
Mailing Address - Country:US
Mailing Address - Phone:704-239-6321
Mailing Address - Fax:844-708-0619
Practice Address - Street 1:644 ABINGTON DR NE
Practice Address - Street 2:
Practice Address - City:CONCORD
Practice Address - State:NC
Practice Address - Zip Code:28025-2568
Practice Address - Country:US
Practice Address - Phone:704-239-6321
Practice Address - Fax:844-708-0619
Is Sole Proprietor?:No
Enumeration Date:2018-08-15
Last Update Date:2018-08-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NCA1696225200000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225200000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapy Assistant