Provider Demographics
NPI:1255023958
Name:SIPPEL, KIRSTIN (PT, DPT, NCS)
Entity type:Individual
Prefix:DR
First Name:KIRSTIN
Middle Name:
Last Name:SIPPEL
Suffix:
Gender:F
Credentials:PT, DPT, NCS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:525 BEACH BLVD
Mailing Address - Street 2:
Mailing Address - City:LAGUNA VISTA
Mailing Address - State:TX
Mailing Address - Zip Code:78578-2627
Mailing Address - Country:US
Mailing Address - Phone:956-572-6535
Mailing Address - Fax:
Practice Address - Street 1:112 W QUEEN ISABELLA STE A
Practice Address - Street 2:
Practice Address - City:PORT ISABEL
Practice Address - State:TX
Practice Address - Zip Code:78578-2970
Practice Address - Country:US
Practice Address - Phone:956-410-1005
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2023-05-22
Last Update Date:2023-05-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX11641602251N0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2251N0400XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical TherapistNeurology