Provider Demographics
NPI:1396738126
Name:FILIPPI, RAPHAEL (PTA)
Entity type:Individual
Prefix:
First Name:RAPHAEL
Middle Name:
Last Name:FILIPPI
Suffix:
Gender:M
Credentials:PTA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 1521
Mailing Address - Street 2:
Mailing Address - City:TULAROSA
Mailing Address - State:NM
Mailing Address - Zip Code:88352-1521
Mailing Address - Country:US
Mailing Address - Phone:505-491-4998
Mailing Address - Fax:505-585-3597
Practice Address - Street 1:807 W LONGHORN RD
Practice Address - Street 2:
Practice Address - City:PAYSON
Practice Address - State:AZ
Practice Address - Zip Code:85541-4263
Practice Address - Country:US
Practice Address - Phone:928-474-1120
Practice Address - Fax:928-474-0505
Is Sole Proprietor?:Yes
Enumeration Date:2005-08-26
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NMA-0476225200000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225200000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapy Assistant