Provider Demographics
NPI:1689948556
Name:SHIPLEY, ANITA ELLEN
Entity Type:Individual
Prefix:MS
First Name:ANITA
Middle Name:ELLEN
Last Name:SHIPLEY
Suffix:
Gender:F
Credentials:
Other - Prefix:MISS
Other - First Name:ANITA
Other - Middle Name:ELLEN
Other - Last Name:KASER
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:66325 REDWOOD RD
Mailing Address - Street 2:
Mailing Address - City:NORTH LIBERTY
Mailing Address - State:IN
Mailing Address - Zip Code:46554-9456
Mailing Address - Country:US
Mailing Address - Phone:574-274-7881
Mailing Address - Fax:
Practice Address - Street 1:66325 REDWOOD RD
Practice Address - Street 2:
Practice Address - City:NORTH LIBERTY
Practice Address - State:IN
Practice Address - Zip Code:46554-9456
Practice Address - Country:US
Practice Address - Phone:574-274-7881
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2012-02-23
Last Update Date:2012-02-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX2086360225200000X
PATEI003078225200000X
IN06004034A225200000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225200000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapy Assistant