Provider Demographics
NPI:1679167183
Name:SHIPP, JOSHUA (MS, LMT, CMT, EP-C)
Entity type:Individual
Prefix:
First Name:JOSHUA
Middle Name:
Last Name:SHIPP
Suffix:
Gender:M
Credentials:MS, LMT, CMT, EP-C
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1222 ATLANTIC AVE
Mailing Address - Street 2:
Mailing Address - City:LONG BEACH
Mailing Address - State:CA
Mailing Address - Zip Code:90813-3315
Mailing Address - Country:US
Mailing Address - Phone:314-706-1579
Mailing Address - Fax:
Practice Address - Street 1:1222 ATLANTIC AVE
Practice Address - Street 2:
Practice Address - City:LONG BEACH
Practice Address - State:CA
Practice Address - Zip Code:90813-3315
Practice Address - Country:US
Practice Address - Phone:314-706-1579
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2021-02-24
Last Update Date:2025-05-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA77199225700000X
CA1070508224Y00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes224Y00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersClinical Exercise Physiologist
No225700000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersMassage Therapist
Provider Identifiers
StateIdentifier IDID TypeIssuer
MO15134787Medicaid