Provider Demographics
NPI:1700069531
Name:PIPPIN, JANET SUE (PT)
Entity Type:Individual
Prefix:MRS
First Name:JANET
Middle Name:SUE
Last Name:PIPPIN
Suffix:
Gender:F
Credentials:PT
Other - Prefix:
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Mailing Address - Street 1:3280 POPPY TRAIL DR
Mailing Address - Street 2:
Mailing Address - City:LAKE HAVASU CITY
Mailing Address - State:AZ
Mailing Address - Zip Code:86406-7816
Mailing Address - Country:US
Mailing Address - Phone:928-453-2553
Mailing Address - Fax:
Practice Address - Street 1:2781 OSBORN DR
Practice Address - Street 2:
Practice Address - City:LAKE HAVASU CITY
Practice Address - State:AZ
Practice Address - Zip Code:86406-8629
Practice Address - Country:US
Practice Address - Phone:928-505-5552
Practice Address - Fax:928-505-2660
Is Sole Proprietor?:No
Enumeration Date:2007-12-15
Last Update Date:2007-12-15
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
AZ552225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist