Provider Demographics
NPI:1104298439
Name:LIPANA, JOSEPH BRYAN (PT, DPT)
Entity type:Individual
Prefix:DR
First Name:JOSEPH
Middle Name:BRYAN
Last Name:LIPANA
Suffix:
Gender:M
Credentials:PT, DPT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:612 ROYAL POINCIANA
Mailing Address - Street 2:
Mailing Address - City:PUNTA GORDA
Mailing Address - State:FL
Mailing Address - Zip Code:33955-1027
Mailing Address - Country:US
Mailing Address - Phone:941-286-6068
Mailing Address - Fax:
Practice Address - Street 1:612 ROYAL POINCIANA
Practice Address - Street 2:
Practice Address - City:PUNTA GORDA
Practice Address - State:FL
Practice Address - Zip Code:33955-1027
Practice Address - Country:US
Practice Address - Phone:941-286-6068
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2015-10-26
Last Update Date:2015-10-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLPT20002225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist