Provider Demographics
NPI:1215084496
Name:TIPTON, TRECA DIANE (PT)
Entity type:Individual
Prefix:MS
First Name:TRECA
Middle Name:DIANE
Last Name:TIPTON
Suffix:
Gender:F
Credentials:PT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Credentials:
Mailing Address - Street 1:928 W FOOTHILL BLVD
Mailing Address - Street 2:
Mailing Address - City:CLAREMONT
Mailing Address - State:CA
Mailing Address - Zip Code:91711-3303
Mailing Address - Country:US
Mailing Address - Phone:909-447-5724
Mailing Address - Fax:909-447-5734
Practice Address - Street 1:928 W FOOTHILL BLVD
Practice Address - Street 2:
Practice Address - City:CLAREMONT
Practice Address - State:CA
Practice Address - Zip Code:91711-3303
Practice Address - Country:US
Practice Address - Phone:909-447-5724
Practice Address - Fax:909-447-5734
Is Sole Proprietor?:Yes
Enumeration Date:2007-01-03
Last Update Date:2010-10-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA32957225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist