Provider Demographics
NPI:1649500810
Name:RILEY-GIPE, BRENDA (PT,CST)
Entity type:Individual
Prefix:MS
First Name:BRENDA
Middle Name:
Last Name:RILEY-GIPE
Suffix:
Gender:F
Credentials:PT,CST
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:225 EMORY LN
Mailing Address - Street 2:
Mailing Address - City:FAIRFIELD
Mailing Address - State:PA
Mailing Address - Zip Code:17320-7831
Mailing Address - Country:US
Mailing Address - Phone:717-357-8628
Mailing Address - Fax:
Practice Address - Street 1:225 EMORY LN
Practice Address - Street 2:
Practice Address - City:FAIRFIELD
Practice Address - State:PA
Practice Address - Zip Code:17320-7831
Practice Address - Country:US
Practice Address - Phone:717-357-8628
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2010-01-11
Last Update Date:2010-01-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PAPT0155402251X0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2251X0800XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical TherapistOrthopedic