Provider Demographics
NPI:1245621929
Name:TIPPMANN, JENNIFER (DPT)
Entity type:Individual
Prefix:DR
First Name:JENNIFER
Middle Name:
Last Name:TIPPMANN
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 1:3110 MALLARD COVE LN
Mailing Address - Street 2:
Mailing Address - City:FORT WAYNE
Mailing Address - State:IN
Mailing Address - Zip Code:46804-2882
Mailing Address - Country:US
Mailing Address - Phone:260-431-8198
Mailing Address - Fax:260-755-0475
Practice Address - Street 1:3110 MALLARD COVE LN
Practice Address - Street 2:
Practice Address - City:FORT WAYNE
Practice Address - State:IN
Practice Address - Zip Code:46804-2882
Practice Address - Country:US
Practice Address - Phone:260-431-8198
Practice Address - Fax:260-755-0475
Is Sole Proprietor?:No
Enumeration Date:2015-02-17
Last Update Date:2019-10-30
Deactivation Date:2019-09-26
Deactivation Code:
Reactivation Date:2019-10-30
Provider Licenses
StateLicense IDTaxonomies
FLPT27423225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist