Provider Demographics
NPI:1649887522
Name:LIPE, KENDEL NICOLE (PT, DPT)
Entity type:Individual
Prefix:
First Name:KENDEL
Middle Name:NICOLE
Last Name:LIPE
Suffix:
Gender:F
Credentials:PT, DPT
Other - Prefix:
Other - First Name:KENDEL
Other - Middle Name:
Other - Last Name:GIDDENS
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:
Mailing Address - Street 1:2200 CANTERBURY ST
Mailing Address - Street 2:
Mailing Address - City:AUSTIN
Mailing Address - State:TX
Mailing Address - Zip Code:78702-5615
Mailing Address - Country:US
Mailing Address - Phone:830-459-1533
Mailing Address - Fax:
Practice Address - Street 1:7401 OLD BEE CAVES RD
Practice Address - Street 2:
Practice Address - City:AUSTIN
Practice Address - State:TX
Practice Address - Zip Code:78735-8234
Practice Address - Country:US
Practice Address - Phone:210-831-8833
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2020-09-25
Last Update Date:2020-09-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX1336837261QP2000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QP2000XAmbulatory Health Care FacilitiesClinic/CenterPhysical Therapy
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX1336867OtherTX DPT LICENSE NUMBER