Provider Demographics
NPI:1205667185
Name:TRIPP, AUTUMN SUZANNE
Entity type:Individual
Prefix:
First Name:AUTUMN
Middle Name:SUZANNE
Last Name:TRIPP
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:997 LOIS RD
Mailing Address - Street 2:
Mailing Address - City:PITTS
Mailing Address - State:GA
Mailing Address - Zip Code:31072-6442
Mailing Address - Country:US
Mailing Address - Phone:229-938-0792
Mailing Address - Fax:
Practice Address - Street 1:1001 GREER ST
Practice Address - Street 2:
Practice Address - City:CORDELE
Practice Address - State:GA
Practice Address - Zip Code:31015-2056
Practice Address - Country:US
Practice Address - Phone:229-207-4004
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2024-08-12
Last Update Date:2024-08-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist