Provider Demographics
NPI:1780671008
Name:LIPPERT, JEAN ANN (MPT)
Entity Type:Individual
Prefix:
First Name:JEAN
Middle Name:ANN
Last Name:LIPPERT
Suffix:
Gender:F
Credentials:MPT
Other - Prefix:
Other - First Name:JEAN
Other - Middle Name:ANN
Other - Last Name:VECCHIO
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:PT
Mailing Address - Street 1:2845 THOR DR
Mailing Address - Street 2:
Mailing Address - City:LOWER BURRELL
Mailing Address - State:PA
Mailing Address - Zip Code:15068-2532
Mailing Address - Country:US
Mailing Address - Phone:724-339-4273
Mailing Address - Fax:
Practice Address - Street 1:2757 LEECHBURG RD
Practice Address - Street 2:
Practice Address - City:LOWER BURRELL
Practice Address - State:PA
Practice Address - Zip Code:15068-3138
Practice Address - Country:US
Practice Address - Phone:724-337-6522
Practice Address - Fax:724-337-0630
Is Sole Proprietor?:Not Answered
Enumeration Date:2005-10-03
Last Update Date:2007-07-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PAPT013623L225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist
Provider Identifiers
StateIdentifier IDID TypeIssuer
PA1011255300001Medicaid
PA167214OtherTHREE RIVERS HEALTH PLAN