Provider Demographics
NPI:1770812216
Name:SHIPP, AMY (LAT, ATC, ITAT)
Entity type:Individual
Prefix:
First Name:AMY
Middle Name:
Last Name:SHIPP
Suffix:
Gender:F
Credentials:LAT, ATC, ITAT
Other - Prefix:
Other - First Name:AMY
Other - Middle Name:
Other - Last Name:PENCE
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:289 SAINT CHARLES WAY
Mailing Address - Street 2:
Mailing Address - City:WHITELAND
Mailing Address - State:IN
Mailing Address - Zip Code:46184-1671
Mailing Address - Country:US
Mailing Address - Phone:812-344-4019
Mailing Address - Fax:
Practice Address - Street 1:9273 N STATE ROAD 9
Practice Address - Street 2:
Practice Address - City:HOPE
Practice Address - State:IN
Practice Address - Zip Code:47246-9760
Practice Address - Country:US
Practice Address - Phone:812-546-4421
Practice Address - Fax:812-546-2005
Is Sole Proprietor?:No
Enumeration Date:2009-12-11
Last Update Date:2017-11-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IN36001373A2255A2300X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2255A2300XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersSpecialist/TechnologistAthletic Trainer