Provider Demographics
NPI:1639514623
Name:GIPITULAN, JUVY (PT)
Entity Type:Individual
Prefix:MRS
First Name:JUVY
Middle Name:
Last Name:GIPITULAN
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 1:1415 ELDRIDGE PKWY
Mailing Address - Street 2:APT 2327
Mailing Address - City:HOUSTON
Mailing Address - State:TX
Mailing Address - Zip Code:77077-1635
Mailing Address - Country:US
Mailing Address - Phone:856-383-0215
Mailing Address - Fax:
Practice Address - Street 1:1415 ELDRIDGE PKWY
Practice Address - Street 2:APT 2327
Practice Address - City:HOUSTON
Practice Address - State:TX
Practice Address - Zip Code:77077-1635
Practice Address - Country:US
Practice Address - Phone:856-383-0215
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2013-05-03
Last Update Date:2013-05-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX1228979225100000X
NJ40QA01299300225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist