Provider Demographics
NPI:1669025383
Name:SIPPLE, JOSEPH L JR (PTA)
Entity Type:Individual
Prefix:
First Name:JOSEPH
Middle Name:L
Last Name:SIPPLE
Suffix:JR
Gender:M
Credentials:PTA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:344 E THOMAS ST
Mailing Address - Street 2:
Mailing Address - City:WILKES BARRE
Mailing Address - State:PA
Mailing Address - Zip Code:18705-3806
Mailing Address - Country:US
Mailing Address - Phone:570-266-2360
Mailing Address - Fax:
Practice Address - Street 1:209 ROBERTS RD
Practice Address - Street 2:
Practice Address - City:PITTSTON
Practice Address - State:PA
Practice Address - Zip Code:18640-3111
Practice Address - Country:US
Practice Address - Phone:570-655-2891
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2019-07-22
Last Update Date:2019-07-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PATE012262225200000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225200000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapy Assistant