Provider Demographics
NPI:1336369289
Name:KIPKER, JOSHUA REX (PT)
Entity Type:Individual
Prefix:MR
First Name:JOSHUA
Middle Name:REX
Last Name:KIPKER
Suffix:
Gender:M
Credentials:PT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3573 W XY AVE
Mailing Address - Street 2:
Mailing Address - City:SCHOOLCRAFT
Mailing Address - State:MI
Mailing Address - Zip Code:49087-9619
Mailing Address - Country:US
Mailing Address - Phone:616-634-6968
Mailing Address - Fax:
Practice Address - Street 1:1580 VALENCIA ST
Practice Address - Street 2:SUITE 701
Practice Address - City:SAN FRANCISCO
Practice Address - State:CA
Practice Address - Zip Code:94110-4423
Practice Address - Country:US
Practice Address - Phone:415-647-6720
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2007-04-25
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA33231225100000X
WAPT00010031225100000X
MI5501012014225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist