Provider Demographics
NPI:1972822856
Name:IPPOLITO, BRIANNE R (DPT)
Entity Type:Individual
Prefix:
First Name:BRIANNE
Middle Name:R
Last Name:IPPOLITO
Suffix:
Gender:F
Credentials:DPT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:530 7TH AVE
Mailing Address - Street 2:SUITE 908
Mailing Address - City:NEW YORK
Mailing Address - State:NY
Mailing Address - Zip Code:10018-4878
Mailing Address - Country:US
Mailing Address - Phone:212-840-3030
Mailing Address - Fax:212-840-3063
Practice Address - Street 1:530 7TH AVE
Practice Address - Street 2:SUITE 908
Practice Address - City:NEW YORK
Practice Address - State:NY
Practice Address - Zip Code:10018-4878
Practice Address - Country:US
Practice Address - Phone:212-840-3030
Practice Address - Fax:212-840-3063
Is Sole Proprietor?:No
Enumeration Date:2010-05-18
Last Update Date:2012-08-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY032467225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist