Provider Demographics
NPI:1811587306
Name:LIPPERT, MARILYN SCHIEWE
Entity Type:Individual
Prefix:
First Name:MARILYN
Middle Name:SCHIEWE
Last Name:LIPPERT
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:MARILYN
Other - Middle Name:
Other - Last Name:LIPPERT
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:
Mailing Address - Street 1:PO BOX 298
Mailing Address - Street 2:
Mailing Address - City:KAMUELA
Mailing Address - State:HI
Mailing Address - Zip Code:96743-0298
Mailing Address - Country:US
Mailing Address - Phone:541-941-0203
Mailing Address - Fax:
Practice Address - Street 1:45-527 PAKALANA ST
Practice Address - Street 2:
Practice Address - City:HONOKAA
Practice Address - State:HI
Practice Address - Zip Code:96727-6986
Practice Address - Country:US
Practice Address - Phone:808-775-8895
Practice Address - Fax:808-775-8898
Is Sole Proprietor?:Yes
Enumeration Date:2021-01-19
Last Update Date:2021-01-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
HI3099225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist