Provider Demographics
NPI:1689723777
Name:CHIPLEY PHYSICAL THERAPY INC
Entity Type:Organization
Organization Name:CHIPLEY PHYSICAL THERAPY INC
Other - Org Name:CHIPLEY PHYSICAL & AQUATIC THERAPY
Other - Org Type:Other Name
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:MR
Authorized Official - First Name:RUBEN
Authorized Official - Middle Name:ALONZO
Authorized Official - Last Name:LAUREL
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:850-638-3387
Mailing Address - Street 1:1567 MAIN ST
Mailing Address - Street 2:
Mailing Address - City:CHIPLEY
Mailing Address - State:FL
Mailing Address - Zip Code:32428-6948
Mailing Address - Country:US
Mailing Address - Phone:850-638-3387
Mailing Address - Fax:850-415-1967
Practice Address - Street 1:1567 MAIN ST
Practice Address - Street 2:
Practice Address - City:CHIPLEY
Practice Address - State:FL
Practice Address - Zip Code:32428-6948
Practice Address - Country:US
Practice Address - Phone:850-638-3387
Practice Address - Fax:850-415-1967
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-01-09
Last Update Date:2022-11-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical TherapistGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
FLY921VOtherBCBS BONIFAY LOCATION
FLY921WOtherBCBS FACILITY NUMBER
FLY921WOtherBCBS FACILITY NUMBER
FLK4575Medicare PIN