Provider Demographics
NPI:1023765302
Name:LIPIC, CAROLINE A (DPT)
Entity type:Individual
Prefix:DR
First Name:CAROLINE
Middle Name:A
Last Name:LIPIC
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 1:250 E SUPERIOR ST STE 14-2219
Mailing Address - Street 2:
Mailing Address - City:CHICAGO
Mailing Address - State:IL
Mailing Address - Zip Code:60611-2914
Mailing Address - Country:US
Mailing Address - Phone:314-960-7492
Mailing Address - Fax:
Practice Address - Street 1:250 E SUPERIOR ST STE 14-2219
Practice Address - Street 2:
Practice Address - City:CHICAGO
Practice Address - State:IL
Practice Address - Zip Code:60611-2914
Practice Address - Country:US
Practice Address - Phone:312-926-6409
Practice Address - Fax:312-926-4412
Is Sole Proprietor?:No
Enumeration Date:2022-03-07
Last Update Date:2023-03-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX1348891225100000X
IL070.026394225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist